Individual
DR. SID MICHAEL TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
446 ROUTE 304, BARDONIA, NY 10954
(845) 623-6666
Mailing address
446 ROUTE 304, BARDONIA, NY 10954
(845) 623-6666
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
048814
NY
Other
Enumeration date
10/06/2010
Last updated
10/06/2010
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