Organization
SOUTH DAYTON ORAL & MAXILLOFACIAL SURGERY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRENT TUCKER DDS, MD (PRESIDENT)
(419) 680-0023
Entity
Organization
Contact information
Practice address
7325 FAR HILLS AVE, DAYTON, OH 45459-4415
(937) 439-1606
Mailing address
7325 FAR HILLS AVE, DAYTON, OH 45459-4415
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
30-02437
OH
Other
Enumeration date
03/20/2015
Last updated
03/20/2015
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