Healthcare Provider Details

I. General information

NPI: 1952796658
Provider Name (Legal Business Name): DENNIS R. LUCAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TAMIAMI TRL N 302
NAPLES FL
34102-5481
US

IV. Provider business mailing address

1000 TAMIAMI TRL N 302
NAPLES FL
34102-5481
US

V. Phone/Fax

Practice location:
  • Phone: 239-262-5851
  • Fax: 239-262-7498
Mailing address:
  • Phone: 239-262-5851
  • Fax: 239-262-7498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS R LUCAS
Title or Position: OWNER
Credential: DMD
Phone: 239-262-5851