MEDICARE: DR. THOMAS DAVID RUCKER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12741	MO
2	122300000X	Dentist	MO012741	MO

General Provider Information

NPI Number	:	1336144310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS DAVID RUCKER DDS

Provider Business Mailing Address
First Line	:	1107 S. CATALPA ST.
Second Line	:
City	:	SAVANNAH
State	:	MO
Zip	:	64485
Country	:	US
Telephone Number	:	816-383-1925
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 S. CATALPA ST.
Second Line	:
City	:	SAVANNAH
State	:	MO
Zip	:	64485
Country	:	US
Telephone Number	:	816-383-1925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	01/13/2012

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