Healthcare Provider Details

I. General information

NPI: 1508562166
Provider Name (Legal Business Name): LUCAS ORTHODONTIC GROUP - BERRY FARMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7020 BERRY FARMS CROSSING
FRANKLIN TN
37064
US

IV. Provider business mailing address

7004 MOORES LN
BRENTWOOD TN
37027-2905
US

V. Phone/Fax

Practice location:
  • Phone: 615-377-7777
  • Fax:
Mailing address:
  • Phone: 615-377-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN LUCAS
Title or Position: OWNER
Credential: DDS
Phone: 615-377-7777