Provider Demographics
NPI:1073001400
Name:TUCKER, STUART W (DDS)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:W
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 1:319 BAY HARBOUR RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-3507
Mailing Address - Country:US
Mailing Address - Phone:208-242-7110
Mailing Address - Fax:
Practice Address - Street 1:734 HARTNESS RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3425
Practice Address - Country:US
Practice Address - Phone:704-872-6534
Practice Address - Fax:704-872-9407
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC119211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry