Provider Demographics
NPI:1437218138
Name:MORSE, LUCIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUCIAN
Middle Name:
Last Name:MORSE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3439 W NORTHERN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-6500
Mailing Address - Country:US
Mailing Address - Phone:602-973-7050
Mailing Address - Fax:602-973-7050
Practice Address - Street 1:3439 W NORTHERN AVE
Practice Address - Street 2:#2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-6500
Practice Address - Country:US
Practice Address - Phone:602-973-7050
Practice Address - Fax:602-973-5447
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ114752Medicaid
AZ860835428Other3500 NORTHERN, PC TIN
AZ860731086OtherMORSE DENTAL, PC TIN
AZ461659458OtherL. MORSE, DMD, P.C. EIN