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General NPI Number Information
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NPI Number | 1548788631
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Entity Type | Organization
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Legal Business Name | BETTY TUCKER, D.D.S., LLC
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Dates
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Enumeration Date | 09/08/2017
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Last Update Date | 09/08/2017
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Provider Practice Location Address
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Address Line | 6438 WILMINGTON PIKE STE 205
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City | CENTERVILLE
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State | OH
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Zip | 45459-7023
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Country | US
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Telephone | 937-848-1116
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Fax |
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Provider Business Mailing Address
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Address Line | 8607 SEA PINES LN
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City | DAYTON
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State | OH
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Zip | 45458-3321
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Country | US
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Telephone | 419-463-0023
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BETTY HUANG TUCKER
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Credential | DDS
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Telephone | 419-463-0023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30.023424
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License Number State | OH
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