Active NPI
Todd Duane Tucker, DDS
- Dentist
- Richland, MI
National Provider Identifier
1043365240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 16980
- Practice address
- 9271 E D Ave
Richland, MI 49083-9497 - Phone
- (269) 629-9817
- Fax
- (269) 629-0195
- NPI assigned
- Jan 25, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 16980 | MI | Primary |
Addresses
Primary practice location
9271 E D Ave
Richland, MI 49083-9497
Mailing address
9271 E D Ave
PO Box 9
Richland, MI 49083-9497
Phone (269) 629-9817
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160526001473 | MI | Order and Referring Only - Dentist | 1850681214 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16980 | MI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gull Lake Dental Care PC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Richland, MI
- NPI 1841345014
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043365240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9271 E D AVE",
"address_2": "PO BOX 9",
"city": "RICHLAND",
"state": "MI",
"postal_code": "490839497",
"telephone_number": "269-629-9817",
"fax_number": "269-629-0195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9271 E D AVE",
"city": "RICHLAND",
"state": "MI",
"postal_code": "490839497",
"telephone_number": "269-629-9817",
"fax_number": "269-629-0195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUCKER",
"first_name": "TODD",
"middle_name": "DUANE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "16980",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.