Provider Demographics
NPI:1437533247
Name:TUCKER, JORDAN ROSS (DDS)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:ROSS
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 F.M 685
Mailing Address - Street 2:#103
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660
Mailing Address - Country:US
Mailing Address - Phone:512-252-4655
Mailing Address - Fax:512-252-4657
Practice Address - Street 1:1616 F.M 685
Practice Address - Street 2:#103
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660
Practice Address - Country:US
Practice Address - Phone:512-252-4655
Practice Address - Fax:512-252-4657
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist