Healthcare Provider Details

I. General information

NPI: 1386142420
Provider Name (Legal Business Name): JOSEPH A. LUCERO D.D.S. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 PARK LN 101
LAFAYETTE CO
80026-3336
US

IV. Provider business mailing address

2575 PARK LN STE 101
LAFAYETTE CO
80026-3336
US

V. Phone/Fax

Practice location:
  • Phone: 303-834-0615
  • Fax: 303-284-5579
Mailing address:
  • Phone: 303-834-0615
  • Fax: 303-284-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number00203172
License Number StateCO

VIII. Authorized Official

Name: DR. JOSEPH ANDREW LUCERO
Title or Position: PRESIDENT
Credential: DDS
Phone: 303-834-0615