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General NPI Number Information
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NPI Number | 1629007505
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Entity Type | Organization
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Legal Business Name | DAVIDSON- TUCKER ORAL SURGERY ASSOCIATES
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 17 ARENTZEN BLVD SUITE #104
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City | CHARLEROI
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State | PA
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Zip | 15022-1085
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Country | US
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Telephone | 724-483-5080
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Fax | 724-483-3760
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Provider Business Mailing Address
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Address Line | 17 ARENTZEN BLVD SUITE #104
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City | CHARLEROI
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State | PA
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Zip | 15022-1085
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Country | US
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Telephone | 724-483-5080
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Fax | 724-483-3760
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Authorized Official
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Title or Position | PRESIDENT, DAVIDSON-TUCKER ORAL SUR
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Name | CHARLES PETER TUCKER
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Credential | D.M.D.
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Telephone | 724-483-5080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS026650-L
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License Number State | PA
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