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General NPI Number Information
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NPI Number | 1265700405
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Entity Type | Organization
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Legal Business Name | LUTZ FAMILY DENTISTRY
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Dates
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Enumeration Date | 12/02/2011
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 60 N. SHERIDAN SUITE 7
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City | LAWTON
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State | OK
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Zip | 73505
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Country | US
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Telephone | 580-355-2000
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Fax | 580-351-9792
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Provider Business Mailing Address
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Address Line | 60 N. SHERIDAN SUITE 7
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City | LAWTON
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State | OK
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Zip | 73505
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Country | US
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Telephone | 580-355-2000
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Fax | 580-351-9792
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. JAMES BEAUFORD LUTZ
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Credential | D.D.S
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Telephone | 580-355-2000
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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 | 5235
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License Number State | OK
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