Provider Demographics
NPI:1417155425
Name:TUCKER, THERESA KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:KAY
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 1:2586 CLOVER ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1115
Mailing Address - Country:US
Mailing Address - Phone:541-884-9555
Mailing Address - Fax:541-882-7423
Practice Address - Street 1:2586 CLOVER ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1115
Practice Address - Country:US
Practice Address - Phone:541-884-9555
Practice Address - Fax:541-882-7423
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8924122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist