Provider Demographics
NPI:1316412885
Name:LUKE MANCUSO DDS
Entity Type:Organization
Organization Name:LUKE MANCUSO DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-643-6400
Mailing Address - Street 1:1600 W VETERANS MEML DR
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-3604
Mailing Address - Country:US
Mailing Address - Phone:337-643-6400
Mailing Address - Fax:
Practice Address - Street 1:1600 W VETERANS MEML DR
Practice Address - Street 2:
Practice Address - City:KAPLAN
Practice Address - State:LA
Practice Address - Zip Code:70548-3604
Practice Address - Country:US
Practice Address - Phone:337-643-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1881906196Medicaid
LA1447742143Medicaid