MEDICARE: TUCKER ROAD DENTAL ASSOCIATES PC

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	21775	MA

General Provider Information

NPI Number	:	1710180559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUCKER ROAD DENTAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	143 ROCKLAND AVE.
Second Line	:
City	:	SO. DARTMOUTH
State	:	MA
Zip	:	02748
Country	:	US
Telephone Number	:	508-996-3133
Fax Number	:	508-996-3134

Provider Business Practice Location Address
First Line	:	1379 TUCKER RD
Second Line	:
City	:	DARTMOUTH
State	:	MA
Zip	:	02747-3152
Country	:	US
Telephone Number	:	508-996-3133
Fax Number	:	508-996-3134

Authorized Official
Title or Position	:	DENTIST
Name	:	MR. PAUL P PONTE
Credential	:	DMD
Telephone Number	:	508-996-3133

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	08/22/2020

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