Provider Demographics
NPI:1326202490
Name:HERRIN, LEE TUCKER (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:TUCKER
Last Name:HERRIN
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 1:5647 HIGHWAY 80 E
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-8907
Mailing Address - Country:US
Mailing Address - Phone:601-936-6108
Mailing Address - Fax:601-906-6109
Practice Address - Street 1:5647 HIGHWAY 80 E
Practice Address - Street 2:SUITE 4
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-8907
Practice Address - Country:US
Practice Address - Phone:601-936-6108
Practice Address - Fax:601-906-6109
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3467-08122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist