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General NPI Number Information
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NPI Number | 1619988771
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Entity Type | Individual
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Provider Name | FRED LUCAS DDS
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Gender | Male
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9933 LAWLER AVE
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City | SKOKIE
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State | IL
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Zip | 60077-3703
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Country | US
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Telephone | 847-675-4867
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Fax |
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Provider Business Mailing Address
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Address Line | 701 THOMPSON BLVD
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-1013
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Country | US
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Telephone |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 019023343
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License Number State | IL
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