MEDICARE: LUCAS AND THOMAS FAMILY DENTISTRY, INC.

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	DN013726	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1114941184	OTHER	GA	GEORGE W.THOMAS, D.D.S.
2	1790946622	OTHER	GA	JASON W. LUCAS, DMD

General Provider Information

NPI Number	:	1316321631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCAS AND THOMAS FAMILY DENTISTRY, INC.

Provider Business Mailing Address
First Line	:	1600 ALICE ST
Second Line	:
City	:	WAYCROSS
State	:	GA
Zip	:	31501-4533
Country	:	US
Telephone Number	:	912-285-3140
Fax Number	:	912-285-0260

Provider Business Practice Location Address
First Line	:	1600 ALICE ST
Second Line	:
City	:	WAYCROSS
State	:	GA
Zip	:	31501-4533
Country	:	US
Telephone Number	:	912-285-3140
Fax Number	:	912-285-0260

Authorized Official
Title or Position	:	OWNER, PRESIDENT
Name	:	DR. JASON W. LUCAS
Credential	:	D.M.D.
Telephone Number	:	912-285-3140

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	07/16/2015

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Directions to “LUCAS AND THOMAS FAMILY DENTISTRY, INC. ” Practice Location

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