Healthcare Provider Details

I. General information

NPI: 1568262897
Provider Name (Legal Business Name): STEPHANIE ANN TUCKER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ANN MOWERY RDH

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 SOLAREX CT UNIT 200
FREDERICK MD
21703-8655
US

IV. Provider business mailing address

604 SOLAREX CT UNIT 200
FREDERICK MD
21703-8655
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-0300
  • Fax:
Mailing address:
  • Phone: 301-662-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number6732
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: