Provider Demographics
NPI:1780690669
Name:TUCKER, PERRY SHEALY (DMD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:SHEALY
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 1:1050 SEVEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-4704
Mailing Address - Country:US
Mailing Address - Phone:803-648-3266
Mailing Address - Fax:803-649-3555
Practice Address - Street 1:1050 SEVEN OAKS DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-4704
Practice Address - Country:US
Practice Address - Phone:803-648-3266
Practice Address - Fax:803-649-3555
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics