Healthcare Provider Details

I. General information

NPI: 1740954072
Provider Name (Legal Business Name): ALLICIA LUCICH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 NEWBERRY ST NW
AIKEN SC
29801-3929
US

IV. Provider business mailing address

4110 BUFFALO TRL
EVANS GA
30809-0959
US

V. Phone/Fax

Practice location:
  • Phone: 803-649-0044
  • Fax: 803-649-0044
Mailing address:
  • Phone: 530-415-9862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN122566
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12371717-9921
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11441
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: