Provider Demographics
NPI:1932249547
Name:DAVID C. TUCKER D.D.S. HERBERT C. ROSEN D.M.D. PC
Entity Type:Organization
Organization Name:DAVID C. TUCKER D.D.S. HERBERT C. ROSEN D.M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-757-2190
Mailing Address - Street 1:111 ELM ST
Mailing Address - Street 2:201
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1967
Mailing Address - Country:US
Mailing Address - Phone:508-757-2190
Mailing Address - Fax:508-797-0523
Practice Address - Street 1:111 ELM ST
Practice Address - Street 2:201
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1967
Practice Address - Country:US
Practice Address - Phone:508-757-2190
Practice Address - Fax:508-797-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty