Provider Demographics
NPI:1548204688
Name:LUCCHESI, JOSEPH (DMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:LUCCHESI
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 1:2872 TURNPIKE ST
Mailing Address - Street 2:
Mailing Address - City:SUSQUEHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18847-2771
Mailing Address - Country:US
Mailing Address - Phone:570-853-3135
Mailing Address - Fax:570-853-3008
Practice Address - Street 1:2872 TURNPIKE ST
Practice Address - Street 2:
Practice Address - City:SUSQUEHANNA
Practice Address - State:PA
Practice Address - Zip Code:18847-2771
Practice Address - Country:US
Practice Address - Phone:570-853-3135
Practice Address - Fax:570-853-3008
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABM2828929122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00863096Medicaid
PA00863096Medicaid