Provider Demographics
NPI:1376925677
Name:THOMAS J LUCAS, DMD, PC
Entity Type:Organization
Organization Name:THOMAS J LUCAS, DMD, PC
Other - Org Name:EAST ALABAMA FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-821-4321
Mailing Address - Street 1:1452 OPELIKA RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-7613
Mailing Address - Country:US
Mailing Address - Phone:334-821-4321
Mailing Address - Fax:334-821-8812
Practice Address - Street 1:1452 OPELIKA RD
Practice Address - Street 2:SUITE E
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-7613
Practice Address - Country:US
Practice Address - Phone:334-821-4321
Practice Address - Fax:334-821-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL61901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty