Provider Demographics
NPI:1124187133
Name:LUCAS, SANDRA THERESE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:THERESE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5706 ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1612
Mailing Address - Country:US
Mailing Address - Phone:630-920-9621
Mailing Address - Fax:
Practice Address - Street 1:2 E 22ND ST
Practice Address - Street 2:GROVE DENTAL ASSOCIATES
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-627-4680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist