Individual
RICHARD C. TATUM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
167 N. MAIN ST, TUBA CITY, AZ 86045
(928) 283-2672
(928) 283-2991
Mailing address
3008 E. BIRCH AVE, TUBA CITY, AZ 86045-0600
(928) 283-2672
(928) 283-2991
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12754
MD
1223G0001X
General Practice Dentistry
Primary
D6672
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
888927
—
AZ
Enumeration date
08/30/2006
Last updated
06/08/2011
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