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General NPI Number Information
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NPI Number | 1174080162
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Entity Type | Individual
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Provider Name | TRACEY S TUCKER DDS
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Gender | Female
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 6274 BAYWATER LN
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City | RICHLAND
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State | MI
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Zip | 49083-9768
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Country | US
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Telephone | 269-366-0909
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Fax |
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Provider Business Mailing Address
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Address Line | 6274 BAYWATER LN
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City | RICHLAND
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State | MI
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Zip | 49083-9768
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Country | US
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Telephone | 269-366-0909
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901017072
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License Number State | MI
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