Provider Demographics
NPI:1548264419
Name:TUCKER, KENT N (DDS)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:N
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KENT
Other - Middle Name:N
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, PA
Mailing Address - Street 1:111 DAVIS ST
Mailing Address - Street 2:PO BOX 699
Mailing Address - City:PILOT MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27041
Mailing Address - Country:US
Mailing Address - Phone:336-368-4708
Mailing Address - Fax:336-368-2672
Practice Address - Street 1:111 DAVIS ST
Practice Address - Street 2:
Practice Address - City:PILOT MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:27041
Practice Address - Country:US
Practice Address - Phone:336-368-4708
Practice Address - Fax:336-368-2672
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice