MEDICARE: LUCID DENTAL PA

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
2	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1811510845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCID DENTAL PA

Provider Business Mailing Address
First Line	:	8435 WURZBACH RD STE 302
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3374
Country	:	US
Telephone Number	:	210-899-6730
Fax Number	:	833-776-0625

Provider Business Practice Location Address
First Line	:	2105 SIDNEY BAKER ST STE 200
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78028-2563
Country	:	US
Telephone Number	:	210-899-6730
Fax Number	:	833-776-0625

Authorized Official
Title or Position	:	OWNER
Name	:	TIFFINI STRATTON
Credential	:	DDS
Telephone Number	:	210-269-3195

Provider Enumeration Date	:	05/26/2020
Last Update Date	:	04/20/2026

Similar Medicare Providers

1427072156 — MRS. SHANA L HANSEN M.D.
Practice Location Address:

2105 SIDNEY BAKER ST STE 200
KERRVILLE, TX
78028-2563

Practice Phone: 210-899-6730
Practice Fax: 833-776-0625

1710163209 — TIFFINI STRATTON DDS
Practice Location Address:

2105 SIDNEY BAKER ST STE 200
KERRVILLE, TX
78028-2563

Practice Phone: 210-899-6730
Practice Fax: 833-776-0625

1942601497 — MR. ADAM BRANCH APRN, FNP-C
Practice Location Address:

2105 SIDNEY BAKER ST STE 200
KERRVILLE, TX
78028-2563

Practice Phone: 210-899-6730
Practice Fax: 833-776-0625

1134920911 — LUCID SLEEP DOCTORS, PLLC
Practice Location Address:

2105 SIDNEY BAKER ST STE 200
KERRVILLE, TX
78028-2563

Practice Phone: 210-899-6730
Practice Fax: 833-776-0625

1346351103 — MICHAEL S GROCKI M.D.P.A.
Practice Location Address:

703 HILL COUNTRY DR STE 201
KERRVILLE, TX
78028-6161

Practice Phone: 830-257-1814
Practice Fax: 830-257-1083

1184209884 — MEGAN KATHLEEN KESTER
Practice Location Address:

1001 WATER ST BLDG A
KERRVILLE, TX
78028-3523

Practice Phone: 830-896-3730
Practice Fax: 830-792-4402

Directions to “LUCID DENTAL PA ” Practice Location

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