Provider Demographics
NPI:1992940829
Name:DONALD N. TUCK DDS LTD
Entity type:Organization
Organization Name:DONALD N. TUCK DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDEENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:N
Authorized Official - Last Name:TUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-969-0654
Mailing Address - Street 1:1121 WARREN AVE.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3571
Mailing Address - Country:US
Mailing Address - Phone:630-969-0654
Mailing Address - Fax:630-969-3601
Practice Address - Street 1:1121 WARREN AVE.
Practice Address - Street 2:SUITE 120
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3571
Practice Address - Country:US
Practice Address - Phone:630-969-0654
Practice Address - Fax:630-969-3601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONALD N. TUCK DDS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty