Healthcare Provider Details

I. General information

NPI: 1427465178
Provider Name (Legal Business Name): JOSEPH LUCERO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
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 TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberD13460
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number00203172
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: