Individual
DR. TAYLOR LOGAN TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2455 MEDICAL CENTER PKWY, SELMA, AL 36701-7756
(334) 872-0486
Mailing address
2455 MEDICAL CENTER PKWY, SELMA, AL 36701-7756
(334) 872-0486
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5723
AL
122300000X
Dentist
8864
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5723
STATE LICENSE
AL
01
—
8864
STATE LICENSE
NC
Enumeration date
09/24/2009
Last updated
08/12/2011
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