MEDICARE: MCKAY BRIAN TUCKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7885	OK

General Provider Information

NPI Number	:	1588356737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKAY BRIAN TUCKER

Provider Business Mailing Address
First Line	:	11720 E 21ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-1833
Country	:	US
Telephone Number	:	918-437-4911
Fax Number	:

Provider Business Practice Location Address
First Line	:	7801 S WESTERN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2411
Country	:	US
Telephone Number	:	918-437-4911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	04/22/2024

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Directions to “ MCKAY BRIAN TUCKER ” Practice Location

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