1467884759 NPI number — EDWARD JOSEPH TUCHOLSKI JR. DDS

Table of content: EDWARD JOSEPH TUCHOLSKI JR. DDS (NPI 1467884759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467884759 NPI number — EDWARD JOSEPH TUCHOLSKI JR. DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUCHOLSKI
Provider First Name:
EDWARD
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1467884759
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
88 MDG
Provider Second Line Business Mailing Address:
4881 SUGAR MAPLE DR.
Provider Business Mailing Address City Name:
WRIGHT-PATTERSON AFB
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-257-0500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 MDG
Provider Second Line Business Practice Location Address:
1055 E. STEWART BLDG 2018
Provider Business Practice Location Address City Name:
PETERSON AFB
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-556-1333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  62827 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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