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General NPI Number Information
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NPI Number | 1811510845
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Entity Type | Organization
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Legal Business Name | LUCID DENTAL, P.A.
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 2105 SIDNEY BAKER ST STE 200
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City | KERRVILLE
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State | TX
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Zip | 78028-2563
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Country | US
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Telephone | 210-899-6730
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Fax | 833-776-0625
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Provider Business Mailing Address
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Address Line | 8435 WURZBACH RD STE 302
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3374
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Country | US
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Telephone | 210-899-6730
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Fax | 833-776-0625
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIFFINI STRATTON
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Credential | DDS
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Telephone | 210-899-6730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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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 |
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License Number State |
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