MEDICARE: DR. CRAIG THOMAS LUSKEY 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	10132	SC
2	1223G0001X	General Practice Dentistry	0401417029	VA
3	122300000X	Dentist	10132	SC

General Provider Information

NPI Number	:	1841803855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG THOMAS LUSKEY DDS

Provider Business Mailing Address
First Line	:	448 HAWKEYE CT
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-5094
Country	:	US
Telephone Number	:	703-888-8089
Fax Number	:

Provider Business Practice Location Address
First Line	:	D 3836 ARDENNES ST
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-6022
Country	:	US
Telephone Number	:	703-888-8089
Fax Number	:

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

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	03/20/2025

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