Provider Demographics
NPI:1558689091
Name:TUCKER, ELEANOR S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:S
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 1:6296 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2009
Mailing Address - Country:US
Mailing Address - Phone:650-992-2745
Mailing Address - Fax:650-992-3436
Practice Address - Street 1:6296 MISSION ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2009
Practice Address - Country:US
Practice Address - Phone:650-992-2745
Practice Address - Fax:650-992-3436
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice