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NPI Code Detail

MEDICARE: DR. JESSICA LUCOVICH DDS

MEDICARE: DR. JESSICA LUCOVICH DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist371313MS

General Provider Information

NPI Number : 1275973067
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSICA LUCOVICH DDS
Provider Business Mailing Address
First Line : 2154 GOODMAN RD W
Second Line :
City : HORN LAKE
State : MS
Zip : 38637-1303
Country : US
Telephone Number : 662-393-9200
Fax Number :
Provider Business Practice Location Address
First Line : 2154 GOODMAN RD W
Second Line :
City : HORN LAKE
State : MS
Zip : 38637-1303
Country : US
Telephone Number : 662-393-9200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2013
Last Update Date : 08/21/2014

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Directions to “ DR. JESSICA LUCOVICH DDS” Practice Location

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