Provider Demographics
NPI:1366052813
Name:TUCKER, DEIDRIX (RDH)
Entity type:Individual
Prefix:
First Name:DEIDRIX
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:DEIDRIX
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:409 K ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3453
Mailing Address - Country:US
Mailing Address - Phone:202-246-3234
Mailing Address - Fax:
Practice Address - Street 1:4 ATLANTIC ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2350
Practice Address - Country:US
Practice Address - Phone:202-540-9862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHYG1001004124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist