MEDICARE: LUCIDA DENTAL PLLC

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

General Provider Information

NPI Number	:	1699028456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCIDA DENTAL PLLC

Provider Business Mailing Address
First Line	:	2887 S RICHEY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-7215
Country	:	US
Telephone Number	:	832-831-5173
Fax Number	:

Provider Business Practice Location Address
First Line	:	2887 S RICHEY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-7215
Country	:	US
Telephone Number	:	831-831-5173
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ENAYAT ASTANI
Credential	:	DDS
Telephone Number	:	832-831-5173

Provider Enumeration Date	:	10/17/2012
Last Update Date	:	03/17/2016

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