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General NPI Number Information
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NPI Number | 1710085675
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Entity Type | Organization
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Legal Business Name | TUCKER ORTHODONTICS
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1050 SEVEN OAKS DR
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City | AIKEN
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State | SC
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Zip | 29803-4704
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Country | US
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Telephone | 803-648-3266
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Fax | 803-649-3555
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Provider Business Mailing Address
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Address Line | 1050 SEVEN OAKS DR
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City | AIKEN
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State | SC
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Zip | 29803-4704
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Country | US
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Telephone | 803-648-3266
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Fax | 803-649-3555
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN WESLEY TUCKER JR.
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Credential | D.M.D.
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Telephone | 803-648-3266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State | SC
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