Healthcare Provider Details

I. General information

NPI: 1780995712
Provider Name (Legal Business Name): LUKE L'HEUREUX D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 KENNEDY MEMORIAL DR
WATERVILLE ME
04901-4538
US

IV. Provider business mailing address

244 KENNEDY MEMORIAL DR
WATERVILLE ME
04901-4538
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-0117
  • Fax:
Mailing address:
  • Phone: 207-873-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number4600
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number4600
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4600
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: