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General NPI Number Information
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NPI Number | 1386051993
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Entity Type | Organization
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Legal Business Name | KAREN BRYANT LUCKETT,DMD,PLLC
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 1121B DELAWARE AVE
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City | MCCOMB
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State | MS
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Zip | 39648-3829
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Country | US
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Telephone | 601-684-3966
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Fax | 601-684-3875
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Provider Business Mailing Address
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Address Line | 1121B DELAWARE AVE
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City | MCCOMB
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State | MS
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Zip | 39648-3829
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Country | US
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Telephone | 601-684-3966
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Fax | 601-684-3875
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. KAREN BRYANT LUCKETT
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Credential | D.M.D.
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Telephone | 601-684-3966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2664-92
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License Number State | MS
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