Provider Demographics
NPI:1871517136
Name:TUCKER, JOHN WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WAYNE
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 NEW ROCHESTER RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-8800
Mailing Address - Country:US
Mailing Address - Phone:603-742-2200
Mailing Address - Fax:603-742-1105
Practice Address - Street 1:113 NEW ROCHESTER RD
Practice Address - Street 2:SUITE 3
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-8800
Practice Address - Country:US
Practice Address - Phone:603-742-2200
Practice Address - Fax:603-742-1105
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13661223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics