Healthcare Provider Details

I. General information

NPI: 1720292873
Provider Name (Legal Business Name): PETER H. LUCAS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E JOPPA RD
TOWSON MD
21286-5418
US

IV. Provider business mailing address

9 WINEBERRY CT
GLEN ARM MD
21057-9138
US

V. Phone/Fax

Practice location:
  • Phone: 410-321-5700
  • Fax:
Mailing address:
  • Phone: 410-882-9025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6912
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: