Provider Demographics
NPI:1811189608
Name:RAY TUCKETT, DDS, PC
Entity Type:Organization
Organization Name:RAY TUCKETT, DDS, PC
Other - Org Name:MARKETPLACE DENTAL EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-545-8700
Mailing Address - Street 1:18610 E. RITTENHOUSE RD
Mailing Address - Street 2:BLDG A, #106
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-4504
Mailing Address - Country:US
Mailing Address - Phone:480-545-8700
Mailing Address - Fax:
Practice Address - Street 1:18610 E. RITTENHOUSE RD
Practice Address - Street 2:BLDG A, #106
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-4504
Practice Address - Country:US
Practice Address - Phone:480-545-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty