Provider Demographics
NPI:1366865552
Name:JOANNA S. LUCIANO PARKER, DDS, PLLC
Entity Type:Organization
Organization Name:JOANNA S. LUCIANO PARKER, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:LUCIANO PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-579-7508
Mailing Address - Street 1:46 TRIFECTA PL STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-5652
Mailing Address - Country:US
Mailing Address - Phone:304-725-0508
Mailing Address - Fax:304-728-8761
Practice Address - Street 1:46 TRIFECTA PL STE 102
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-5652
Practice Address - Country:US
Practice Address - Phone:304-725-0508
Practice Address - Fax:304-728-8761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV06586Medicaid