Provider Demographics
NPI:1013108554
Name:WILLIAM L. TUCKER, DDS, PLC
Entity Type:Organization
Organization Name:WILLIAM L. TUCKER, DDS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-784-5944
Mailing Address - Street 1:22905 W MAIN ST
Mailing Address - Street 2:PO BOX 905
Mailing Address - City:ARMADA
Mailing Address - State:MI
Mailing Address - Zip Code:48005-3225
Mailing Address - Country:US
Mailing Address - Phone:586-784-5944
Mailing Address - Fax:586-784-5644
Practice Address - Street 1:22905 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ARMADA
Practice Address - State:MI
Practice Address - Zip Code:48005-3225
Practice Address - Country:US
Practice Address - Phone:586-784-5944
Practice Address - Fax:586-784-5644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901015113261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental