MEDICARE: RONALD LUKE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN12349	FL

General Provider Information

NPI Number	:	1306267521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD LUKE DDS

Provider Business Mailing Address
First Line	:	3730 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7141
Country	:	US
Telephone Number	:	239-772-8868
Fax Number	:

Provider Business Practice Location Address
First Line	:	3730 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7141
Country	:	US
Telephone Number	:	239-772-8868
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	12/16/2013

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