Provider Demographics
NPI:1518340686
Name:ST. MARIE, LUKE
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:ST. MARIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10741 INTERLAKE AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8907
Mailing Address - Country:US
Mailing Address - Phone:425-271-1727
Mailing Address - Fax:
Practice Address - Street 1:17900 TALBOT RD S
Practice Address - Street 2:STE #103
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-8212
Practice Address - Country:US
Practice Address - Phone:425-271-1727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60576836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist