MEDICARE: DR. JOHN J LUCIANI III 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	122300000X	Dentist	DS042211	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902461221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN J LUCIANI III DMD

Provider Business Mailing Address
First Line	:	1001 S GEORGE ST
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17403-3676
Country	:	US
Telephone Number	:	717-851-2655
Fax Number	:

Provider Business Practice Location Address
First Line	:	2675 E CUMBERLAND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3727
Country	:	US
Telephone Number	:	215-426-7307
Fax Number	:	215-695-2217

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

Provider Enumeration Date	:	05/02/2019
Last Update Date	:	03/08/2022

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