Provider Demographics
NPI:1053373175
Name:TUCKER, DAVID ISAAC (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ISAAC
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2410 STANLEY ROAD
Mailing Address - Street 2:DENTAC SUITE 200J
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6230
Mailing Address - Country:US
Mailing Address - Phone:210-295-2743
Mailing Address - Fax:210-295-2602
Practice Address - Street 1:2410 STANLEY ROAD
Practice Address - Street 2:DENTAC SUITE 200J
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6230
Practice Address - Country:US
Practice Address - Phone:210-295-2743
Practice Address - Fax:210-295-2602
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX00213801223G0001X
TX213801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice