MEDICARE: DR. PATRICK MAARTEN LUCAS-PERRY 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	1223G0001X	General Practice Dentistry	2901600831	MI

General Provider Information

NPI Number	:	1629655766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK MAARTEN LUCAS-PERRY DDS

Provider Business Mailing Address
First Line	:	211 WINDWARD CT
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-5054
Country	:	US
Telephone Number	:	810-691-7871
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 WILDER RD BAY CITY
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2173
Country	:	US
Telephone Number	:	989-895-6600
Fax Number	:

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

Provider Enumeration Date	:	03/25/2021
Last Update Date	:	05/28/2021

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Directions to “ DR. PATRICK MAARTEN LUCAS-PERRY DDS” Practice Location

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