Provider Demographics
NPI:1093334468
Name:TUCKER, BRIANNA (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 WALNUT ST UNIT 5R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-4026
Mailing Address - Country:US
Mailing Address - Phone:718-902-9018
Mailing Address - Fax:
Practice Address - Street 1:2848 CHURCH AVE # 201B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-8270
Practice Address - Country:US
Practice Address - Phone:718-282-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0638181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics