Provider Demographics
NPI:1194041137
Name:LUCAS J. NAZARIO-CORREA, D.M.D., P.A.
Entity Type:Organization
Organization Name:LUCAS J. NAZARIO-CORREA, D.M.D., P.A.
Other - Org Name:SMILE FOREVER FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENRT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:NAZARIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-295-4694
Mailing Address - Street 1:1006 LYNDHURST FALLS LN
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-9716
Mailing Address - Country:US
Mailing Address - Phone:919-295-4694
Mailing Address - Fax:
Practice Address - Street 1:6406 MCCRIMMON PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-8144
Practice Address - Country:US
Practice Address - Phone:919-295-4694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC82941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty