Provider Demographics
NPI:1710134283
Name:ROBERT L. TUCKER, DDS
Entity Type:Organization
Organization Name:ROBERT L. TUCKER, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-624-1472
Mailing Address - Street 1:105 RIDGEWAY ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7102
Mailing Address - Country:US
Mailing Address - Phone:501-624-1472
Mailing Address - Fax:501-321-0155
Practice Address - Street 1:105 RIDGEWAY ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7102
Practice Address - Country:US
Practice Address - Phone:501-624-1472
Practice Address - Fax:501-321-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2561122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty