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NPI Code Detail

MEDICARE: DR. MICHAEL KENT DELUKE D.D.S, M.D.S

MEDICARE: DR. MICHAEL KENT DELUKE D.D.S, M.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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry050161-1NY
21223X0400XOrthodontics and Dentofacial Orthopedics DentistryDN30313FL

General Provider Information

NPI Number : 1982694097
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL KENT DELUKE D.D.S, M.D.S
Provider Business Mailing Address
First Line : 29 BANCKER AVE
Second Line :
City : SCOTIA
State : NY
Zip : 12302-3103
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12655 COLLIER BLVD
Second Line :
City : NAPLES
State : FL
Zip : 34116-4005
Country : US
Telephone Number : 239-658-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2005
Last Update Date : 01/21/2026

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