Organization
DAVIDSON- TUCKER ORAL SURGERY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES PETER TUCKER D.M.D. (PRESIDENT, DAVIDSON-TUCKER ORAL SUR)
(724) 483-5080
Entity
Organization
Contact information
Practice address
17 ARENTZEN BLVD, SUITE #104, CHARLEROI, PA 15022-1085
(724) 483-5080
(724) 483-3760
Mailing address
17 ARENTZEN BLVD, SUITE #104, CHARLEROI, PA 15022-1085
(724) 483-5080
(724) 483-3760
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS026650-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0525357
—
PA
Enumeration date
07/02/2006
Last updated
08/22/2020
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