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General NPI Number Information
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NPI Number | 1831252840
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Entity Type | Individual
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Provider Name | JONATHAN DANIEL TUCKER DDS
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 05/13/2009
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Provider Practice Location Address
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Address Line | 10703 E. CRYSTAL FALLS PKWY
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City | LEANDER
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State | TX
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Zip | 78641-2259
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Country | US
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Telephone | 512-260-9333
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Fax | 512-260-9331
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Provider Business Mailing Address
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Address Line | 2504 HILLTOP ST
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City | ROUND ROCK
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State | TX
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Zip | 78681-1600
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Country | US
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Telephone | 512-260-9333
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Fax | 512-260-9331
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 22102
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License Number State | TX
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