Provider Demographics
NPI:1407407232
Name:TUCKER, ANGEL SIERRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:SIERRA
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 1:3199 8TH ST NE APT 2515
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-1667
Mailing Address - Country:US
Mailing Address - Phone:225-223-9692
Mailing Address - Fax:
Practice Address - Street 1:55 M ST SE STE 103
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3563
Practice Address - Country:US
Practice Address - Phone:225-223-9692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70301223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice