Provider Demographics
NPI:1568660074
Name:LUZAR, RICKEY EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICKEY
Middle Name:EDWARD
Last Name:LUZAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 BARTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3143
Mailing Address - Country:US
Mailing Address - Phone:321-631-0606
Mailing Address - Fax:321-631-7041
Practice Address - Street 1:895 BARTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3143
Practice Address - Country:US
Practice Address - Phone:321-631-0606
Practice Address - Fax:321-631-7041
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN60511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice