Provider Demographics
NPI:1952320913
Name:TUCKER, MEHRNOUSH E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEHRNOUSH
Middle Name:E
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12011 BLACKBERRY TER
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4921
Mailing Address - Country:US
Mailing Address - Phone:301-330-7618
Mailing Address - Fax:
Practice Address - Street 1:17902 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2231
Practice Address - Country:US
Practice Address - Phone:301-774-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12542122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist