MEDICARE: DR. JAMES PATRICK LUCERO D.D.S.

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	60296	KS

General Provider Information

NPI Number	:	1750386025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES PATRICK LUCERO D.D.S.

Provider Business Mailing Address
First Line	:	1812 E MARY ST
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-3652
Country	:	US
Telephone Number	:	620-275-4782
Fax Number	:	620-275-1413

Provider Business Practice Location Address
First Line	:	1812 E MARY ST
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-3652
Country	:	US
Telephone Number	:	620-275-4782
Fax Number	:	620-275-1413

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	03/26/2024

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