Provider Demographics
NPI:1417953175
Name:LUCAS, KATHLEEN JO (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:JO
Last Name:LUCAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 E WALNUT ST
Mailing Address - Street 2:#208
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1451
Mailing Address - Country:US
Mailing Address - Phone:626-793-6930
Mailing Address - Fax:626-793-6950
Practice Address - Street 1:959 E WALNUT ST
Practice Address - Street 2:#208
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1451
Practice Address - Country:US
Practice Address - Phone:626-793-6930
Practice Address - Fax:626-793-6950
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice