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General NPI Number Information
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NPI Number | 1760691265
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Entity Type | Individual
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Provider Name | LUKAS JOHN PYTLIK DDS
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 4130 LA JOLLA VILLAGE DR SUITE #204
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City | LA JOLLA
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State | CA
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Zip | 92037-9121
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Country | US
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Telephone | 858-452-8933
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Fax | 858-452-5927
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Provider Business Mailing Address
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Address Line | 4130 LA JOLLA VILLAGE DR SUITE #204
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City | LA JOLLA
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State | CA
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Zip | 92037-9121
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Country | US
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Telephone | 858-452-8933
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Fax | 858-452-5927
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D55141
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License Number State | CA
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