| NPI | 1710215819 |
|---|---|
| Former Name | BETTY TUCKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: OH 30-023424) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9005) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: KY 9005) | |
| Enumeration Date | 2009-12-01 |
| Last Update Date | 2022-09-30 |