Provider Demographics
NPI:1609206275
Name:TUCKER, PERRON LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:PERRON
Middle Name:LEE
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2496 ROCKY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2850
Mailing Address - Country:US
Mailing Address - Phone:205-822-6669
Mailing Address - Fax:205-822-6656
Practice Address - Street 1:2496 ROCKY RIDGE RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-2850
Practice Address - Country:US
Practice Address - Phone:205-822-6669
Practice Address - Fax:205-822-6656
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice