Provider Demographics
NPI:1508625328
Name:DAVIS-TUCKER, DENNIS PATRICK
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:PATRICK
Last Name:DAVIS-TUCKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31878 DEL OBISPO ST STE 111
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3223
Mailing Address - Country:US
Mailing Address - Phone:949-558-5051
Mailing Address - Fax:
Practice Address - Street 1:31878 DEL OBISPO ST STE 111
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3223
Practice Address - Country:US
Practice Address - Phone:949-558-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3731237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist