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: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6351 W RIO GRANDE AVE
KENNEWICK WA
99336-7634
US

IV. Provider business mailing address

PO BOX 190
TOPPENISH WA
98948-0190
US

V. Phone/Fax

Practice location:
  • Phone: 509-579-5830
  • Fax:
Mailing address:
  • Phone: 509-865-2395
  • Fax: 509-865-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN-DEN-LIC-28425
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEFC.DF.70142969
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3822
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number20821
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEFC.DF.70142969
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2882
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: