Provider Demographics
NPI:1194814897
Name:LUCKE, REBECCA F (DDS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:F
Last Name:LUCKE
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 1:615 E APPLEBY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3914
Mailing Address - Country:US
Mailing Address - Phone:479-521-3310
Mailing Address - Fax:479-521-9850
Practice Address - Street 1:615 E APPLEBY RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3914
Practice Address - Country:US
Practice Address - Phone:479-521-3310
Practice Address - Fax:479-521-9850
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR866764OtherUNITED CONCORDIA
AR5T027OtherBC/