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General NPI Number Information
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NPI Number | 1952598310
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Entity Type | Organization
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Legal Business Name | TUCKER & ALLEN-JOHNSON DDS PA
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 01/12/2011
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Provider Practice Location Address
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Address Line | 2975 CROUSE LANE
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City | BURLINGTON
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State | NC
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Zip | 27215-8833
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Country | US
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Telephone | 336-538-1608
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Fax |
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Provider Business Mailing Address
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Address Line | 2975 CROUSE LANE
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City | BURLINGTON
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State | NC
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Zip | 27215-8833
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Country | US
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Telephone | 336-538-1608
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NIKKI GIOVONNE TUCKER
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Credential | DDS
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Telephone | 336-538-1608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7497
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License Number State | NC
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