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General NPI Number Information
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NPI Number | 1205057700
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Entity Type | Individual
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Provider Name | ALBERT LUCAS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10056 PINES BLVD.
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City | PEMBROKE PINES
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State | FL
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Zip | 33156
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Country | US
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Telephone | 954-432-7223
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Fax |
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Provider Business Mailing Address
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Address Line | 11141 SW 64TH AVENUE
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City | PINECREST
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State | FL
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Zip | 33156
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Country | US
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Telephone | 305-669-4669
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Fax | 305-669-9101
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN13116
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License Number State | FL
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