Individual
DR. CHARLES R. TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
515 COLLEGE AVE, ALVA, OK 73717-2202
(580) 327-2277
(580) 327-3223
Mailing address
515 COLLEGE AVE. P.O. BOX 388, ALVA, OK 73717
(580) 327-2277
(580) 327-3223
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3416
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
075021
BC/BS OF KANSAS PROVIDER
KS
01
—
3416
OKLAHOMA STATE LICENSE
OK
Enumeration date
10/04/2006
Last updated
07/08/2007
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