Provider Demographics
NPI:1093334468
Name:TUCKER, BRIANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 WALNUT ST UNIT 5R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-4026
Mailing Address - Country:US
Mailing Address - Phone:718-902-9018
Mailing Address - Fax:
Practice Address - Street 1:400 W ALLEGHENY AVE STE B1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-3614
Practice Address - Country:US
Practice Address - Phone:215-291-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist