Provider Demographics
NPI:1114473576
Name:LUCAS, TATIANA O (DDS)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:O
Last Name:LUCAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 CROSS ROADS PLZ
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-2288
Mailing Address - Country:US
Mailing Address - Phone:724-547-0690
Mailing Address - Fax:724-547-1918
Practice Address - Street 1:272 CROSS ROADS PLZ
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666
Practice Address - Country:US
Practice Address - Phone:724-547-0690
Practice Address - Fax:724-547-1918
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV4232122300000X
PADS041087122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032153500002Medicaid