Provider Demographics
NPI:1164160537
Name:TUCKER, ANSHELLE (DMD)
Entity type:Individual
Prefix:
First Name:ANSHELLE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18492 E RANCH RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5397
Mailing Address - Country:US
Mailing Address - Phone:702-755-5395
Mailing Address - Fax:
Practice Address - Street 1:561 FIRST COLONIAL BLVD
Practice Address - Street 2:STE 104
Practice Address - City:V IRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451
Practice Address - Country:US
Practice Address - Phone:757-648-7473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859406122300000X
AZD0120161223G0001X
VA0401419243122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice