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General NPI Number Information
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NPI Number | 1245812684
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Entity Type | Individual
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Provider Name | LUCAS TODD WHITTLE DMD
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Gender | Male
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 2620 N MAIN ST
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City | JAMESTOWN
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State | KY
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Zip | 42629-2541
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Country | US
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Telephone | 859-495-2442
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Fax |
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Provider Business Mailing Address
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Address Line | 576 WATER WORKS RD
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City | JAMESTOWN
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State | KY
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Zip | 42629-7840
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Country | US
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Telephone | 270-566-3115
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 10631
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10631
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License Number State | KY
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