Provider Demographics
NPI:1942227491
Name:TUCKER, TIMOTHY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LEE
Last Name:TUCKER
Suffix:
Gender:M
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:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:DREXEL
Mailing Address - State:NC
Mailing Address - Zip Code:28619-0848
Mailing Address - Country:US
Mailing Address - Phone:828-437-6135
Mailing Address - Fax:828-430-8128
Practice Address - Street 1:300 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:DREXEL
Practice Address - State:NC
Practice Address - Zip Code:28619-0848
Practice Address - Country:US
Practice Address - Phone:828-437-6135
Practice Address - Fax:828-430-8128
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC41241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC98598OtherBLUE CROSS BLUE SHIELD
NC8998598Medicaid