MEDICARE: DR. LUKAS GILEVICIUS 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	7188	LA

General Provider Information

NPI Number	:	1386218881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUKAS GILEVICIUS DDS

Provider Business Mailing Address
First Line	:	4750 NELSON RD STE 100
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5382
Country	:	US
Telephone Number	:	337-210-8864
Fax Number	:

Provider Business Practice Location Address
First Line	:	4750 NELSON RD STE 100
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5382
Country	:	US
Telephone Number	:	337-210-8864
Fax Number	:

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

Provider Enumeration Date	:	05/18/2021
Last Update Date	:	08/30/2021

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