Provider Demographics
NPI:1063635167
Name:TUCKER, GLORIA ESHRAGHI (DDS)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:ESHRAGHI
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 OLIVE WAY STE 524
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1736
Mailing Address - Country:US
Mailing Address - Phone:106-622-6693
Mailing Address - Fax:206-233-1923
Practice Address - Street 1:509 OLIVE WAY STE 524
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1736
Practice Address - Country:US
Practice Address - Phone:106-622-6693
Practice Address - Fax:206-233-1923
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist