Provider Demographics
NPI:1396066882
Name:RUCKER, CHASTITY LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:CHASTITY
Middle Name:LYNN
Last Name:RUCKER
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 1:1540 ROCK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6141
Mailing Address - Country:US
Mailing Address - Phone:615-220-6161
Mailing Address - Fax:615-220-6116
Practice Address - Street 1:1540 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6141
Practice Address - Country:US
Practice Address - Phone:615-220-6161
Practice Address - Fax:615-220-6116
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN93951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry