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General NPI Number Information
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NPI Number | 1366510588
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Entity Type | Individual
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Provider Name | ANJALI JAIN LUECK DMD
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Gender | Female
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 100 ROYAL PALMS DR
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-3921
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Country | US
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Telephone | 904-241-5342
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Fax | 904-241-5966
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Provider Business Mailing Address
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Address Line | 100 ROYAL PALMS DR
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-3921
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Country | US
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Telephone | 904-241-5342
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Fax | 42-415-9669
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 16187
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License Number State | FL
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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 | DN16187
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License Number State | FL
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