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General NPI Number Information
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NPI Number | 1326202490
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Entity Type | Individual
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Provider Name | LEE TUCKER HERRIN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 5647 HIGHWAY 80 E SUITE 4
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City | PEARL
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State | MS
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Zip | 39208-8907
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Country | US
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Telephone | 601-936-6108
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Fax | 601-906-6109
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Provider Business Mailing Address
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Address Line | 5647 HIGHWAY 80 E SUITE 4
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City | PEARL
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State | MS
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Zip | 39208-8907
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Country | US
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Telephone | 601-936-6108
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Fax | 601-906-6109
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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 | 3467-08
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License Number State | MS
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