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General NPI Number Information
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NPI Number | 1700388014
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Entity Type | Individual
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Provider Name | LUKE DAVID VICKERS DDS
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Gender | Male
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 5901 E 7TH ST
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City | LONG BEACH
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State | CA
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Zip | 90822-5201
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Country | US
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Telephone | 562-826-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 572
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City | ESCONDIDO
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State | CA
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Zip | 92033-0572
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Country | US
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Telephone | 760-859-6032
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DT-2960
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D15159
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 103524
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License Number State | CA
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