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General NPI Number Information
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NPI Number | 1871718833
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Entity Type | Organization
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Legal Business Name | STEVEN R. TUCKER P.S.C.
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 909 SCHERM RD
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City | OWENSBORO
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State | KY
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Zip | 42301-6048
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Country | US
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Telephone | 270-926-4107
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Fax | 270-926-4166
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Provider Business Mailing Address
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Address Line | 909 SCHERM RD
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City | OWENSBORO
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State | KY
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Zip | 42301-6048
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Country | US
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Telephone | 270-926-4107
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Fax | 270-926-4166
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Authorized Official
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Title or Position | CEO
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Name | DR. STEVEN R. TUCKER
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Credential | D.M.D.
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Telephone | 270-926-4107
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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 | 4475
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License Number State | KY
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