MEDICARE: DR. ANJALI JAIN LUECK DMD

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
1	1223G0001X	General Practice Dentistry	16187	FL
2	1223G0001X	General Practice Dentistry	DN16187	FL

General Provider Information

NPI Number	:	1366510588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANJALI JAIN LUECK DMD

Provider Business Mailing Address
First Line	:	100 ROYAL PALMS DR
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-3921
Country	:	US
Telephone Number	:	904-241-5342
Fax Number	:	42-415-9669

Provider Business Practice Location Address
First Line	:	100 ROYAL PALMS DR
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-3921
Country	:	US
Telephone Number	:	904-241-5342
Fax Number	:	904-241-5966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	05/06/2025

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