# SOUTH DAYTON ORAL & MAXILLOFACIAL SURGERY INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942694583
- **Authorized official:** TRENT TUCKER DDS, MD (PRESIDENT)
- **Authorized official phone:** (419) 680-0023

## Contact information

- **Practice address:** 7325 FAR HILLS AVE, DAYTON, OH 45459-4415
- **Practice address phone:** (937) 439-1606
- **Mailing address:** 7325 FAR HILLS AVE, DAYTON, OH 45459-4415

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 30-02437 | OH | Yes |

## Other

- **Enumeration date:** 03/20/2015
- **Last updated:** 03/20/2015