Provider Demographics
NPI:1093491896
Name:DUCK, IRENE (DMD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:DUCK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:474 INDUSTRIAL LN
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841
Mailing Address - Country:US
Mailing Address - Phone:423-286-8600
Mailing Address - Fax:
Practice Address - Street 1:474 INDUSTRIAL LN
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841
Practice Address - Country:US
Practice Address - Phone:423-286-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist