Provider Demographics
NPI:1184879447
Name:TUCKER, JOSEPH COY (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:COY
Last Name:TUCKER
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 1:3126 S BOULEVARD # 207
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5308
Mailing Address - Country:US
Mailing Address - Phone:405-562-7778
Mailing Address - Fax:405-562-7778
Practice Address - Street 1:17917 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-8960
Practice Address - Country:US
Practice Address - Phone:405-562-7778
Practice Address - Fax:405-562-7778
Is Sole Proprietor?:No
Enumeration Date:2008-11-28
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice