Healthcare Provider Details

I. General information

NPI: 1427124676
Provider Name (Legal Business Name): MICHELLE JUDITH-MARIE CHARLES LUCHEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE JUDITH-MARIE LUCHEY CHARLES DDS

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 N SEMORAN BLVD
ORLANDO FL
32807-3326
US

IV. Provider business mailing address

544 N SEMORAN BLVD
ORLANDO FL
32807-3326
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-7500
  • Fax: 407-277-4713
Mailing address:
  • Phone: 407-277-7500
  • Fax: 407-277-4713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN14237
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number031573700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: