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General NPI Number Information
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NPI Number | 1154765980
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Entity Type | Individual
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Provider Name | DANIEL B LUCKENBILL MD
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Gender | Male
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 3535 PENTAGON BLVD STE 320
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City | BEAVERCREEK
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State | OH
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Zip | 45431-1705
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Country | US
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Telephone | 937-433-5309
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Fax | 937-298-0287
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Provider Business Mailing Address
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Address Line | 3535 PENTAGON BLVD STE 320
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City | BEAVERCREEK
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State | OH
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Zip | 45431-1705
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Country | US
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Telephone | 937-433-5309
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Fax | 937-298-0287
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 35.136839
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License Number State | OH
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