Provider Demographics
NPI:1679157705
Name:DRS. HARRISON & TUCKER
Entity type:Organization
Organization Name:DRS. HARRISON & TUCKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:731-686-3956
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-0506
Mailing Address - Country:US
Mailing Address - Phone:731-686-3061
Mailing Address - Fax:731-723-4067
Practice Address - Street 1:4129 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3164
Practice Address - Country:US
Practice Address - Phone:731-686-3956
Practice Address - Fax:731-723-4067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental