MEDICARE: MRS. MARTHA R. 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	122300000X	Dentist	35947	CA
2	1223G0001X	General Practice Dentistry	35947	CA

General Provider Information

NPI Number	:	1861655417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTHA R. LUCERO D.D.S.

Provider Business Mailing Address
First Line	:	12833 HARBOR BLVD
Second Line	:	SUITE F-3
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-5806
Country	:	US
Telephone Number	:	714-534-9480
Fax Number	:	714-534-9482

Provider Business Practice Location Address
First Line	:	12833 HARBOR BLVD
Second Line	:	SUITE F-3
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-5806
Country	:	US
Telephone Number	:	714-534-9480
Fax Number	:

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

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	02/25/2013

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