Lucking, Kathleen Marie
Lucking, Kathleen Marie is an individual health care provider with primary practice located at 5400 Coraci Blvd Apt 6102 , Port Orange FL 32128-7576. She recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Student, Health Care / Student in an Organized Health Care Education/Training Program. Dental Providers / Dentist is her primary health care specialty. Lucking, Kathleen Marie can be contacted via phone (989) 708-1384.Contact Information
Primary practice address
5400 Coraci Blvd Apt 6102
Port Orange FL 32128-7576
Phone: (989) 708-1384
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 019029445 | Illinois |
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Dental Providers / Dentist | 122300000X | DN24377 | Florida |
Profile Details
| NPI number | 1912345042 |
|---|---|
| LBN Legal business name | Lucking, Kathleen Marie |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 11th, 2013 |
| Last updated | Aug 27th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912345042 | NPPES |
| Florida | MEDICAID | 14430849 |
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