Provider Demographics
NPI:1245374289
Name:TUCKER, DONALD ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ANDREW
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 1:6622 MAIN ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5968
Mailing Address - Country:US
Mailing Address - Phone:716-631-9554
Mailing Address - Fax:716-631-9536
Practice Address - Street 1:6622 MAIN ST
Practice Address - Street 2:SUITE #5
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5968
Practice Address - Country:US
Practice Address - Phone:716-631-9554
Practice Address - Fax:716-631-9536
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist