Provider Demographics
NPI:1225042906
Name:LUCK, MARK H (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:LUCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:114 LOVELL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1984
Mailing Address - Country:US
Mailing Address - Phone:865-675-9030
Mailing Address - Fax:865-675-9003
Practice Address - Street 1:114 LOVELL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1984
Practice Address - Country:US
Practice Address - Phone:865-675-9030
Practice Address - Fax:865-675-9003
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNTN 38011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice