Healthcare Provider Details

I. General information

NPI: 1740352335
Provider Name (Legal Business Name): MARK STEPHEN LUCIER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 S RESERVE ST STE D
MISSOULA MT
59801-7652
US

IV. Provider business mailing address

955 MAIN ST
SANFORD ME
04073-3574
US

V. Phone/Fax

Practice location:
  • Phone: 65-417-3374
  • Fax:
Mailing address:
  • Phone: 508-757-1727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number20821
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3822
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2882
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN-DEN-LIC-28425
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: