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General NPI Number Information
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NPI Number | 1316321631
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Entity Type | Organization
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Legal Business Name | LUCAS AND THOMAS FAMILY DENTISTRY, INC.
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 1600 ALICE ST
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City | WAYCROSS
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State | GA
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Zip | 31501-4533
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Country | US
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Telephone | 912-285-3140
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Fax | 912-285-0260
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Provider Business Mailing Address
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Address Line | 1600 ALICE ST
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City | WAYCROSS
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State | GA
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Zip | 31501-4533
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Country | US
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Telephone | 912-285-3140
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Fax | 912-285-0260
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | DR. JASON W. LUCAS
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Credential | D.M.D.
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Telephone | 912-285-3140
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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 | DN013726
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License Number State | GA
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