Provider Demographics
NPI:1629354980
Name:LUCARIO, PAULETTE (DDS)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:LUCARIO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 JOLIET AVE
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:IL
Mailing Address - Zip Code:60534-1192
Mailing Address - Country:US
Mailing Address - Phone:708-447-3200
Mailing Address - Fax:
Practice Address - Street 1:4212 JOLIET AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:IL
Practice Address - Zip Code:60534-1192
Practice Address - Country:US
Practice Address - Phone:708-447-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190288031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice