Provider Demographics
NPI:1457645202
Name:LUCAS-PERRY, VICTORIA MONIQUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:MONIQUE
Last Name:LUCAS-PERRY
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 1:68 BRADHURST AVE
Mailing Address - Street 2:APT 6E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3304
Mailing Address - Country:US
Mailing Address - Phone:810-691-3567
Mailing Address - Fax:
Practice Address - Street 1:4727 SAINT ANTOINE ST
Practice Address - Street 2:APT 6E
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1461
Practice Address - Country:US
Practice Address - Phone:313-833-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001086122300000X
NY056249-1122300000X
MI2901020509122300000X
MD14902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist