Active NPI
Jonathan Daniel Tucker, DDS
- General Practice Dentistry
- Leander, TX
National Provider Identifier
1831252840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 22102
- Practice address
- 10703 E. Crystal Falls Pkwy
Leander, TX 78641-2259 - Phone
- (512) 260-9333
- Fax
- (512) 260-9331
- NPI assigned
- Dec 19, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 22102 | TX | Primary |
Addresses
Primary practice location
10703 E. Crystal Falls Pkwy
Leander, TX 78641-2259
Mailing address
2504 Hilltop St
Round Rock, TX 78681-1600
Phone (512) 260-9333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 173246301 | Medicaid | TX |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22102 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crystal Falls Family Dentistry, PLLC | Past | Accepting new patients | |
| Crystal Falls Family Dentistry ,PLLC. | General Practice | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Dentistry
- Leander, TX
- NPI 1497955710
-
- Dental Clinic/Center
- Leander, TX
- NPI 1417135625
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242172800000",
"number": "1831252840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2504 HILLTOP ST",
"city": "ROUND ROCK",
"state": "TX",
"postal_code": "786811600",
"telephone_number": "512-260-9333",
"fax_number": "512-260-9331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10703 E. CRYSTAL FALLS PKWY",
"city": "LEANDER",
"state": "TX",
"postal_code": "786412259",
"telephone_number": "512-260-9333",
"fax_number": "512-260-9331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUCKER",
"first_name": "JONATHAN",
"middle_name": "DANIEL",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-19",
"last_updated": "2009-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "22102",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "173246301",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Leander, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.