1689050452 NPI number — AMY CROOM KUKER, DDS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689050452 NPI number — AMY CROOM KUKER, DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMY CROOM KUKER, DDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689050452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3727 NW 63RD ST
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73116-1931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-810-8995
Provider Business Mailing Address Fax Number:
405-810-8984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3727 NW 63RD ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73116-1931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-810-8995
Provider Business Practice Location Address Fax Number:
405-810-8984
Provider Enumeration Date:
08/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KUKER
Authorized Official First Name:
AMY
Authorized Official Middle Name:
CROOM
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
405-810-8995

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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