Provider Demographics
NPI:1437648292
Name:VERA, LUKE C (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:C
Last Name:VERA
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 1:1067 TWINING DR
Mailing Address - Street 2:
Mailing Address - City:BARKSDALE AFB
Mailing Address - State:LA
Mailing Address - Zip Code:71110-2486
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DENTAL CLINIC, 1067 TWINING DRIVE
Practice Address - Street 2:
Practice Address - City:BARKSDALE AIR FORCE BASE
Practice Address - State:LA
Practice Address - Zip Code:71111-2425
Practice Address - Country:US
Practice Address - Phone:318-456-6791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA75001223S0112X
PADS041940122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1333341OtherDRIVER'S LICENSE
LA7500OtherLA DENTAL LICENCE