Provider Demographics
NPI:1316033608
Name:TUCKER, BRIAN DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DAVID
Last Name:TUCKER
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 FAR WEST BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3299
Mailing Address - Country:US
Mailing Address - Phone:512-346-5738
Mailing Address - Fax:512-346-3241
Practice Address - Street 1:3508 FAR WEST BLVD STE 310
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3299
Practice Address - Country:US
Practice Address - Phone:512-346-5738
Practice Address - Fax:512-346-3241
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice