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General NPI Number Information
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NPI Number | 1679157705
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Entity Type | Organization
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Legal Business Name | DRS. HARRISON & TUCKER
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 4129 S 1ST ST
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City | MILAN
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State | TN
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Zip | 38358-3164
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Country | US
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Telephone | 731-686-3956
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Fax | 731-723-4067
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Provider Business Mailing Address
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Address Line | PO BOX 506
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City | MILAN
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State | TN
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Zip | 38358-0506
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Country | US
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Telephone | 731-686-3061
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Fax | 731-723-4067
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Authorized Official
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Title or Position | OWNER
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Name | JOHN W TUCKER JR.
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Credential | D.D.S.
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Telephone | 731-686-3956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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