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 1:6 CHATHAM ST APT 305
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1344
Mailing Address - Country:US
Mailing Address - Phone:702-755-5395
Mailing Address - Fax:
Practice Address - Street 1:9057 E TALKING STICK WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-8521
Practice Address - Country:US
Practice Address - Phone:480-296-0379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0120161223G0001X
MADN1859406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice