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General NPI Number Information
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NPI Number | 1710134283
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Entity Type | Organization
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Legal Business Name | ROBERT L. TUCKER, DDS
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 105 RIDGEWAY ST
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City | HOT SPRINGS
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State | AR
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Zip | 71901-7102
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Country | US
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Telephone | 501-624-1472
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Fax | 501-321-0155
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Provider Business Mailing Address
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Address Line | 105 RIDGEWAY ST
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City | HOT SPRINGS
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State | AR
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Zip | 71901-7102
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Country | US
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Telephone | 501-624-1472
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Fax | 501-321-0155
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT L. TUCKER
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Credential | DDS
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Telephone | 501-624-1472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2561
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License Number State | AR
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