MEDICARE: DR. ROBERT THOMAS LUCERO 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	122300000X	Dentist	DD1070	NM

General Provider Information

NPI Number	:	1982754131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT THOMAS LUCERO DDS

Provider Business Mailing Address
First Line	:	1710 WYOMING BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-3855
Country	:	US
Telephone Number	:	505-299-9122
Fax Number	:	505-293-1275

Provider Business Practice Location Address
First Line	:	1710 WYOMING BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-3855
Country	:	US
Telephone Number	:	505-299-9122
Fax Number	:	505-293-1275

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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