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General NPI Number Information
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NPI Number | 1477859130
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Entity Type | Organization
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Legal Business Name | L.G. PUCKETT D.D.S.
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 508 N CHURCH ST
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City | LIVINGSTON
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State | TN
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Zip | 38570-1539
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Country | US
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Telephone | 931-823-3754
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Fax | 931-823-3739
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Provider Business Mailing Address
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Address Line | 508 N CHURCH ST
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City | LIVINGSTON
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State | TN
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Zip | 38570-1539
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Country | US
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Telephone | 931-823-3754
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Fax | 931-823-3739
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LUTHER G PUCKETT IV
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Credential | DDS
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Telephone | 931-823-3754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8548
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License Number State | TN
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