Provider Demographics
NPI:1568262897
Name:TUCKER, STEPHANIE ANN (RDH)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:TUCKER
Suffix:
Gender:
Credentials:RDH
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:MOWERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:604 SOLAREX CT UNIT 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8655
Mailing Address - Country:US
Mailing Address - Phone:301-662-0300
Mailing Address - Fax:
Practice Address - Street 1:604 SOLAREX CT UNIT 200
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8655
Practice Address - Country:US
Practice Address - Phone:301-662-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6732124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist