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General NPI Number Information
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NPI Number | 1285882860
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Entity Type | Individual
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Provider Name | EDWIN LEE TUCKER D.M.D
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Gender | Male
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Dates
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Enumeration Date | 09/08/2008
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Last Update Date | 09/08/2008
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Provider Practice Location Address
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Address Line | 210 SUTTON RD SE
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City | OWENS CROSS ROADS
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State | AL
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Zip | 35763-8753
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Country | US
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Telephone | 256-534-1475
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Fax | 256-533-1425
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Provider Business Mailing Address
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Address Line | 210 SUTTON RD SE
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City | OWENS CROSS ROADS
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State | AL
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Zip | 35763-8753
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Country | US
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Telephone | 256-534-1475
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Fax | 256-533-1425
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 4131
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License Number State | AL
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