Active NPI
Ives Henry Tucker, D.D.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Brooklyn, NY
National Provider Identifier
1184748972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 037253-1
- Practice address
- 7105 21St Ave
Brooklyn, NY 11204-5850 - Phone
- (718) 256-0022
- NPI assigned
- Mar 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 037253-1 | NY | Primary |
Addresses
Primary practice location
7105 21St Ave
Brooklyn, NY 11204-5850
Mailing address
4 Williamsburg CT
East Brunswick, NJ 08816-3249
Phone (732) 238-7751
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00771802 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 037253-1 | NY | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1184748972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 WILLIAMSBURG CT",
"city": "EAST BRUNSWICK",
"state": "NJ",
"postal_code": "088163249",
"telephone_number": "732-238-7751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7105 21ST AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112045850",
"telephone_number": "718-256-0022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUCKER",
"first_name": "IVES",
"middle_name": "HENRY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NY",
"license": "037253-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00771802",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.