Provider Demographics
NPI:1518186634
Name:STEVEN C TUCKER, D.D.S., L.L.C.
Entity Type:Organization
Organization Name:STEVEN C TUCKER, D.D.S., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-223-2882
Mailing Address - Street 1:1103 OAK PARK DR
Mailing Address - Street 2:#105
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6273
Mailing Address - Country:US
Mailing Address - Phone:970-223-2882
Mailing Address - Fax:970-223-4944
Practice Address - Street 1:1103 OAK PARK DR
Practice Address - Street 2:#105
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-6273
Practice Address - Country:US
Practice Address - Phone:970-223-2882
Practice Address - Fax:970-223-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO05488122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty