Provider Demographics
NPI:1417250754
Name:DR. JAMES LUCIDO,DDS LLC
Entity Type:Organization
Organization Name:DR. JAMES LUCIDO,DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANGELO
Authorized Official - Last Name:LUCIDO
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:330-821-0441
Mailing Address - Street 1:721 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-2932
Mailing Address - Country:US
Mailing Address - Phone:330-821-0441
Mailing Address - Fax:
Practice Address - Street 1:3800 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9029
Practice Address - Country:US
Practice Address - Phone:330-533-3400
Practice Address - Fax:330-533-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0179851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty