Provider Demographics
NPI:1063589711
Name:SCOTT F TUCKER, DDS MS PA
Entity type:Organization
Organization Name:SCOTT F TUCKER, DDS MS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:F
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-213-3336
Mailing Address - Street 1:PO BOX 505117
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5117
Mailing Address - Country:US
Mailing Address - Phone:781-213-3336
Mailing Address - Fax:781-224-4216
Practice Address - Street 1:2287 CLOVERDALE AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2301
Practice Address - Country:US
Practice Address - Phone:704-547-1970
Practice Address - Fax:704-547-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993101Medicaid
NC2414166BMedicare ID - Type Unspecified
NC8993101Medicaid