Provider Demographics
NPI:1750465050
Name:RUCKER, PATRICIA KING (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:KING
Last Name:RUCKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:406 CHESTERFIELD AVE
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29721-0906
Mailing Address - Country:US
Mailing Address - Phone:803-283-9969
Mailing Address - Fax:803-283-9907
Practice Address - Street 1:406 CHESTERFIELD AVE
Practice Address - Street 2:406 CHESTERFIELD AVE.
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-3508
Practice Address - Country:US
Practice Address - Phone:803-283-9969
Practice Address - Fax:803-283-9907
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC34311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ34311Medicaid