Provider Demographics
NPI:1740405752
Name:TUCKER, LLOYD M (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:M
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 E 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6224
Mailing Address - Country:US
Mailing Address - Phone:206-937-8253
Mailing Address - Fax:206-937-8186
Practice Address - Street 1:624 E 8TH STREET
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6224
Practice Address - Country:US
Practice Address - Phone:360-452-7482
Practice Address - Fax:360-457-4903
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000077591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics