Healthcare Provider Details

I. General information

NPI: 1902229776
Provider Name (Legal Business Name): LUCAS ORTHODONTICS BELLE MEADE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 HARDING PIKE SUITE 110
NASHVILLE TN
37205-2119
US

IV. Provider business mailing address

7004 MOORES LN
BRENTWOOD TN
37027-2905
US

V. Phone/Fax

Practice location:
  • Phone: 615-383-5152
  • 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 NumberDS7361
License Number StateTN

VIII. Authorized Official

Name: JONATHAN D LUCAS
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 615-383-5152