Individual
DR. MYRON R TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
411 BILLINGSLEY RD, SUITE 105, CHARLOTTE, NC 28211-1066
(704) 347-3900
(704) 347-0133
Mailing address
411 BILLINGSLEY RD, SUITE 105, CHARLOTTE, NC 28211-1066
(704) 347-3900
(704) 347-0133
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5193
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
899853B
—
NC
01
—
9853B
BCBS
NC
Enumeration date
02/15/2006
Last updated
10/17/2007
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