Provider Demographics
NPI:1619080504
Name:LUKES, NATHAN ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ROBERT
Last Name:LUKES
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 1693
Mailing Address - Street 2:
Mailing Address - City:GIRDWOOD
Mailing Address - State:AK
Mailing Address - Zip Code:99587-1693
Mailing Address - Country:US
Mailing Address - Phone:907-783-0214
Mailing Address - Fax:907-562-2253
Practice Address - Street 1:3340 ARCTIC BLVD
Practice Address - Street 2:#104
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4523
Practice Address - Country:US
Practice Address - Phone:907-561-5154
Practice Address - Fax:907-561-2253
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD09641Medicaid