Provider Demographics
NPI:1225522949
Name:LUCKHARDT, PLLC
Entity Type:Organization
Organization Name:LUCKHARDT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:336-314-0873
Mailing Address - Street 1:4901 ROBDOT DR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-9207
Mailing Address - Country:US
Mailing Address - Phone:336-314-0873
Mailing Address - Fax:
Practice Address - Street 1:10801 WOODLAND BEAVER ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215
Practice Address - Country:US
Practice Address - Phone:704-888-0607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-16
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10124261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental