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NPI 1104904036
● Active Type 2 · Organization
Alan C. Tucker, D.d.s., P.c.
Dentist · Lilburn, GA · NPI 1104904036
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Enumerated 2006 · 19 years on NPI
Alan C. Tucker, D.d.s., P.c. is 1 of 358 dentist organizations in Georgia.
NPI age
19 years
Enumerated 2006-11-01
Primary specialty
Dentist
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Tucker
President
Last NPPES update
2020-08-22
Source: monthly bulk 2026-05
How this organization compares
Across 358 active dentist providers in Georgia.
NPI age
19 years
≈ at median (18 yr)
Practice locations
1
0 secondary on file
NPI lifetime · 2006 → 2026
2006-11 Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
639a Beaver Ruin Rd Nw
Lilburn, GA 300473401
📞 7709235200 fax 7705640613
Mailing address
639a Beaver Ruin Rd Nw
Lilburn, GA 300473401
📞 7709235200 fax 7705640613
Authorized official
Alan Charles Tucker, D.D.S.
President
📞 7709235200
Individual providers at this organization
1 individual provider on file at this primary practice address.
Specialties
Dentist
Primary
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
GA license #10864 taxonomy 1223S0112X
Practice context
Multi-provider organization.
1 individual provider on file at this primary address.
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How to verify this organization
Confirm the NPI on NPPES. The CMS registry is the system of record. Open NPPES →
Verify the organization is in good standing. Cross-check with the state's business registration and any applicable licensing boards.
Confirm payer enrollment if billing. NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.
Updated 2026-05-14
· Source: CMS NPPES bulk export. Praxis MD refreshes the directory monthly with weekly delta updates.
Independent public resource. Not affiliated with CMS, HHS, or NPPES. Not endorsed by the U.S. government.
NPI listing is not proof of active licensure or payer enrollment.