Provider Demographics
NPI:1851510291
Name:KENT N. TUCKER,D.D.S.,P.A.
Entity Type:Organization
Organization Name:KENT N. TUCKER,D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:N
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-368-4708
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:PILOT MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27041-0699
Mailing Address - Country:US
Mailing Address - Phone:336-368-4708
Mailing Address - Fax:336-368-2672
Practice Address - Street 1:111 DAVIS ST
Practice Address - Street 2:
Practice Address - City:PILOT MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:27041
Practice Address - Country:US
Practice Address - Phone:336-368-4708
Practice Address - Fax:336-368-2672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty