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General NPI Number Information
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NPI Number | 1245232594
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Entity Type | Organization
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Legal Business Name | RICHARD B. LUCZAK, DDS, MPH, PA
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 4251 FM 2181 STE 264
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City | CORINTH
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State | TX
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Zip | 76210-4220
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Country | US
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Telephone | 940-497-3000
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Fax | 940-497-3010
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Provider Business Mailing Address
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Address Line | 4251 FM 2181 STE 264
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City | CORINTH
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State | TX
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Zip | 76210-4220
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Country | US
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Telephone | 940-497-3000
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Fax | 940-497-3010
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD BERNARD LUCZAK
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Credential | DDS, MPH
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Telephone | 940-497-3000
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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 | 19398
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License Number State | TX
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