Provider Demographics
NPI:1568175875
Name:JOHN LUCIANI DMD LLC
Entity Type:Organization
Organization Name:JOHN LUCIANI DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LUCIANI
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-818-4059
Mailing Address - Street 1:516 GREEN LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2619
Mailing Address - Country:US
Mailing Address - Phone:215-482-4250
Mailing Address - Fax:215-428-4250
Practice Address - Street 1:516 GREEN LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2619
Practice Address - Country:US
Practice Address - Phone:215-482-4250
Practice Address - Fax:215-428-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental