Provider Demographics
NPI:1609362979
Name:KAUFMAN, LUCAS BENJAMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:BENJAMIN
Last Name:KAUFMAN
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:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:MOORCROFT
Mailing Address - State:WY
Mailing Address - Zip Code:82721-0909
Mailing Address - Country:US
Mailing Address - Phone:307-756-9301
Mailing Address - Fax:307-756-9301
Practice Address - Street 1:111 S BIG HORN AVE
Practice Address - Street 2:
Practice Address - City:MOORCROFT
Practice Address - State:WY
Practice Address - Zip Code:82721
Practice Address - Country:US
Practice Address - Phone:307-756-9301
Practice Address - Fax:307-756-9301
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY14981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice