Provider Demographics
NPI:1558323873
Name:TUCKER, PATRICIA W (DMD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:W
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 1:1018 WESTGATE PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2327
Mailing Address - Country:US
Mailing Address - Phone:502-419-7971
Mailing Address - Fax:
Practice Address - Street 1:902 DUPONT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4602
Practice Address - Country:US
Practice Address - Phone:502-895-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6595/6051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics