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General NPI Number Information
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NPI Number | 1659439917
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Entity Type | Organization
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Legal Business Name | A W TUCKER DDS PA
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 120 SOUTH JOHNSON STREET
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City | BREVARD
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State | NC
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Zip | 28712
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Country | US
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Telephone | 828-884-2191
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Fax | 828-877-3069
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Provider Business Mailing Address
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Address Line | 120 SOUTH JOHNSON STREET
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City | BREVARD
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State | NC
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Zip | 28712
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Country | US
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Telephone | 828-884-2191
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Fax | 828-877-3069
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. AUGUSTINE WASHINGTON TUCKER III
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Credential | DDS
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Telephone | 828-884-2191
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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 | 3617
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License Number State | NC
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