Provider Demographics
NPI:1164862553
Name:RUCKER, AARON R (DMD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:R
Last Name:RUCKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003
Mailing Address - Country:US
Mailing Address - Phone:801-756-8686
Mailing Address - Fax:801-763-5651
Practice Address - Street 1:233 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003
Practice Address - Country:US
Practice Address - Phone:801-756-8686
Practice Address - Fax:801-765-5651
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029495122300000X
UT13490263-8903122300000X
UT13490263-9923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist