Organization
L.G. PUCKETT D.D.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUTHER G PUCKETT IV DDS (DENTIST)
(931) 823-3754
Entity
Organization
Contact information
Practice address
508 N CHURCH ST, LIVINGSTON, TN 38570-1539
(931) 823-3754
(931) 823-3739
Mailing address
508 N CHURCH ST, LIVINGSTON, TN 38570-1539
(931) 823-3754
(931) 823-3739
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8548
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5440979
—
TN
Enumeration date
01/28/2011
Last updated
01/28/2011
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