Provider Demographics
NPI:1225888746
Name:DYEVSGLAM
Entity Type:Organization
Organization Name:DYEVSGLAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRANIAL PROTHESIS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-580-9818
Mailing Address - Street 1:89 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:PA
Mailing Address - Zip Code:19475-1887
Mailing Address - Country:US
Mailing Address - Phone:484-580-9818
Mailing Address - Fax:
Practice Address - Street 1:89 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:PA
Practice Address - Zip Code:19475-1887
Practice Address - Country:US
Practice Address - Phone:484-580-9818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty