=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912025883
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD D LUKE DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2007
-----------------------------------------------------
Last Update Date | 09/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3730 DEL PRADO BLVD S
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-772-8868
-----------------------------------------------------
Fax | 239-471-7669
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3730 DEL PRADO BLVD S
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-772-8868
-----------------------------------------------------
Fax | 239-471-7669
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RONALD DEAN LUKE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 239-772-8868
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN12349
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------