Healthcare Provider Details

I. General information

NPI: 1578777405
Provider Name (Legal Business Name): MICHAEL STUART LUCAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 YGNACIO VALLEY RD B2
WALNUT CREEK CA
94598-3391
US

IV. Provider business mailing address

713 CITRUS AVE
CONCORD CA
94518-2338
US

V. Phone/Fax

Practice location:
  • Phone: 925-933-4522
  • Fax:
Mailing address:
  • Phone: 925-798-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number38871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: