Provider Demographics
NPI:1629113204
Name:LUCHETTI, CARL J (DMD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:J
Last Name:LUCHETTI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 PENNSFORD DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3679
Mailing Address - Country:US
Mailing Address - Phone:610-692-8121
Mailing Address - Fax:610-696-6457
Practice Address - Street 1:795 E MARSHALL ST
Practice Address - Street 2:SUITE 306
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4400
Practice Address - Country:US
Practice Address - Phone:610-692-8121
Practice Address - Fax:610-696-6457
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-24231-L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics