DR. SHAVON TUCKER DDS
NPI 1316780422
Dentist in Milwaukee, WI

Q: What is Shavon Tucker's NPI number?

The NPI number for Shavon Tucker is 1316780422. It was assigned to this individual provider in the NPPES registry on June 17, 2024.

Q: What is Shavon Tucker's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Q: When was this NPI record last updated?

The NPPES record for Shavon Tucker was last updated on July 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 17, 2024PECOS Enrolled

2555 N DR MARTIN LUTHER KING JR DR, MILWAUKEE, WI 53212(414) 267-2670(414) 562-8432 Get Directions Write a Review

NPPES record last updated: July 17, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Dr. Shavon Tucker Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SHAVON TUCKER DDS (NPI 1316780422) is an individual dentist in Milwaukee, Wisconsin, licensed in Wisconsin (6001651-15) and active in the NPI registry since June 2024. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2024).

NPPES Registry Identity

NPI1316780422

Entity TypeIndividualFemale

Primary Taxonomy122300000X

Provider Legal NameDR. SHAVON TUCKERCredential: DDS

Location Address2555 N DR MARTIN LUTHER KING JR DRMilwaukee, WI 53212-2709

Mailing Address2555 N Dr Martin Luther King Jr DrMilwaukee, WI 53212-2709 · (414) 267-2670 · Fax (414) 562-8432

Phone(414) 267-2670

Fax(414) 562-8432

Sole ProprietorNo

Medical School CMSOtherGraduated 2024

Enumeration DateJune 17, 2024

Last NPPES UpdateJuly 17, 2025

NPPES CertifiedJuly 15, 2025

✔ NPI 1316780422 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

Licenses✔ Licensed in WI · 6001651-15✔ Licensed in MO · 2024022265

Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Also ListedDentist · General PracticeTaxonomy 1223G0001X · License 6001651-15 (WI)

2555 N DR MARTIN LUTHER KING JR DR, Milwaukee, WI 53212

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Secondary Practice Locations 2

Location 11153 NE Rice RdLees Summit, MO 64086-6788 · Phone (816) 477-7070

Location 28200 W Silver Spring DrMilwaukee, WI 53218-2552 · Phone (414) 267-2671 · Fax (414) 464-7258

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Shavon Tucker Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8426565979

PECOS Enrollment IDI20250729002696

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53212 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$67.37 typical visit price

range $17.40 – $133.76

Typical copayment $16.84 (range $4.35 – $33.44)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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