Individual
TODD S TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.,M.D.
Contact information
Practice address
330 S GARDEN WAY, SUITE 140, EUGENE, OR 97401
(541) 686-9750
(541) 485-5034
Mailing address
330 S GARDEN WAY, SUITE 140, EUGENE, OR 97401
(541) 686-9750
(541) 485-5034
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
22003
OR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D7325
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190009241
PALMETTO
OR
05
—
288056
—
OR
05
—
295498
—
OR
Enumeration date
07/27/2006
Last updated
03/24/2010
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