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NPI Code Detail

MEDICARE: DR. KATHLEEN JO LUCAS DDS

MEDICARE: DR. KATHLEEN JO LUCAS 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
11223G0001XGeneral Practice Dentistry34282CA

General Provider Information

NPI Number : 1417953175
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHLEEN JO LUCAS DDS
Provider Business Mailing Address
First Line : 959 E WALNUT ST
Second Line : #208
City : PASADENA
State : CA
Zip : 91106-1451
Country : US
Telephone Number : 626-793-6930
Fax Number : 626-793-6950
Provider Business Practice Location Address
First Line : 959 E WALNUT ST
Second Line : #208
City : PASADENA
State : CA
Zip : 91106-1451
Country : US
Telephone Number : 626-793-6930
Fax Number : 626-793-6950
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 10/19/2010

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Directions to “ DR. KATHLEEN JO LUCAS DDS” Practice Location

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