Provider Demographics
NPI:1457524449
Name:TUCKER, SHEILA E (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:E
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-6516
Mailing Address - Country:US
Mailing Address - Phone:978-475-0567
Mailing Address - Fax:978-475-7169
Practice Address - Street 1:123 ABBOT ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-4835
Practice Address - Country:US
Practice Address - Phone:978-475-9412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159081223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics