Provider Demographics
NPI:1710180559
Name:TUCKER ROAD DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:TUCKER ROAD DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:PONTE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-996-3133
Mailing Address - Street 1:143 ROCKLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:SO. DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748
Mailing Address - Country:US
Mailing Address - Phone:508-996-3133
Mailing Address - Fax:508-996-3134
Practice Address - Street 1:1379 TUCKER RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3152
Practice Address - Country:US
Practice Address - Phone:508-996-3133
Practice Address - Fax:508-996-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty