Provider Demographics
NPI:1568843761
Name:SHIPMAN, LUCAS (DDS)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:SHIPMAN
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 1:1800 S PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-2800
Mailing Address - Country:US
Mailing Address - Phone:903-569-5569
Mailing Address - Fax:903-569-1601
Practice Address - Street 1:1800 S PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-2800
Practice Address - Country:US
Practice Address - Phone:903-569-5569
Practice Address - Fax:903-569-1601
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice