Provider Demographics
NPI:1467976878
Name:DR. TATIANA LUCAS, DDS FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:DR. TATIANA LUCAS, DDS FAMILY DENTISTRY, PLLC
Other - Org Name:PRIME DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:O
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:724-547-0690
Mailing Address - Street 1:272 CROSSROADS PLZ UNIT 4
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-2288
Mailing Address - Country:US
Mailing Address - Phone:724-547-0690
Mailing Address - Fax:724-547-1918
Practice Address - Street 1:272 CROSS ROADS PLZ
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-2288
Practice Address - Country:US
Practice Address - Phone:724-547-0690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033533390001Medicaid