Healthcare Provider Details

I. General information

NPI: 1720962343
Provider Name (Legal Business Name): PEYTON ROSE TUCCINARD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR B7500
FT CARSON CO
80913-4613
US

IV. Provider business mailing address

1650 COCHRANE CIR B7500
FT CARSON CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 719-503-7167
  • Fax:
Mailing address:
  • Phone: 719-503-7167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS045164
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: