Provider Demographics
NPI:1134204324
Name:TUCKE, AARON G (DDS)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:G
Last Name:TUCKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 W. 159TH STREET
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477
Mailing Address - Country:US
Mailing Address - Phone:708-429-4770
Mailing Address - Fax:708-429-9685
Practice Address - Street 1:4435 WEST 95TH STREET
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-423-5990
Practice Address - Fax:708-423-8555
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190269651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
K35517Medicare PIN
K35518Medicare PIN
K35515Medicare PIN
K35516Medicare PIN