Provider Demographics
NPI:1710215819
Name:TUCKER, BETTY HUANG (DDS)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:HUANG
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BETTY HUANG
Mailing Address - Street 1:2200 OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2858
Mailing Address - Country:US
Mailing Address - Phone:419-463-0023
Mailing Address - Fax:
Practice Address - Street 1:2200 OLYMPIC ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2858
Practice Address - Country:US
Practice Address - Phone:937-390-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9005122300000X, 1223P0221X
OH30-0234241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054438Medicaid