Provider Demographics
NPI:1720286990
Name:TUCKER, RICHARD DEREK (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DEREK
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 1:103A REGENCY COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-5210
Mailing Address - Country:US
Mailing Address - Phone:864-801-8877
Mailing Address - Fax:
Practice Address - Street 1:103A REGENCY COMMONS DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-5210
Practice Address - Country:US
Practice Address - Phone:864-801-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice