Provider Demographics
NPI:1992108880
Name:TUCKER, BRIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 SPUR 591
Mailing Address - Street 2:ATTN: REGIONAL MEDICAL OFFICE
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79107-9606
Mailing Address - Country:US
Mailing Address - Phone:806-381-7081
Mailing Address - Fax:
Practice Address - Street 1:9601 SPUR 591
Practice Address - Street 2:ATTN: REGIONAL MEDICAL OFFICE
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-9606
Practice Address - Country:US
Practice Address - Phone:806-381-7081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice