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General NPI Number Information
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NPI Number | 1194041137
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Entity Type | Organization
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Legal Business Name | LUCAS J. NAZARIO-CORREA, D.M.D., P.A.
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 04/15/2010
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Provider Practice Location Address
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Address Line | 6406 MCCRIMMON PKWY SUITE 220
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City | MORRISVILLE
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State | NC
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Zip | 27560-8144
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Country | US
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Telephone | 919-295-4694
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Fax |
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Provider Business Mailing Address
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Address Line | 1006 LYNDHURST FALLS LN
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City | KNIGHTDALE
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State | NC
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Zip | 27545-9716
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Country | US
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Telephone | 919-295-4694
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Fax |
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Authorized Official
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Title or Position | PRESIDENRT
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Name | DR. LUCAS J NAZARIO
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Credential | DMD
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Telephone | 919-295-4694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8294
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License Number State | NC
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