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NPI Code Detail

MEDICARE: BRIAN D. TUCKER, DMD, PC

MEDICARE: BRIAN D. TUCKER, DMD, PC
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
11223G0001XGeneral Practice Dentistry22655TX

General Provider Information

NPI Number : 1699074419
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIAN D. TUCKER, DMD, PC
Provider Business Mailing Address
First Line : 3508 FAR WEST BLVD STE 310
Second Line :
City : AUSTIN
State : TX
Zip : 78731-3080
Country : US
Telephone Number : 512-346-5738
Fax Number : 512-346-3241
Provider Business Practice Location Address
First Line : 3508 FAR WEST BLVD STE 310
Second Line :
City : AUSTIN
State : TX
Zip : 78731-3080
Country : US
Telephone Number : 512-346-5738
Fax Number : 512-346-3241
Authorized Official
Title or Position : DENTIST/OWNER
Name : DR. BRIAN D TUCKER
Credential : D.M.D.
Telephone Number : 512-346-5738
Provider Enumeration Date : 03/18/2011
Last Update Date : 03/18/2011

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