Provider Demographics
NPI:1689050452
Name:AMY CROOM KUKER, DDS
Entity Type:Organization
Organization Name:AMY CROOM KUKER, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:CROOM
Authorized Official - Last Name:KUKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-810-8995
Mailing Address - Street 1:3727 NW 63RD ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1931
Mailing Address - Country:US
Mailing Address - Phone:405-810-8995
Mailing Address - Fax:405-810-8984
Practice Address - Street 1:3727 NW 63RD ST
Practice Address - Street 2:SUITE 107
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1931
Practice Address - Country:US
Practice Address - Phone:405-810-8995
Practice Address - Fax:405-810-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty