Healthcare Provider Details

I. General information

NPI: 1902461684
Provider Name (Legal Business Name): STEVEN J TUCKER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S FIFTH ST STE 250
MEBANE NC
27302-9896
US

IV. Provider business mailing address

1107 S FIFTH ST STE 250
MEBANE NC
27302-9896
US

V. Phone/Fax

Practice location:
  • Phone: 919-563-2873
  • Fax:
Mailing address:
  • Phone: 919-563-2873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14484
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: