Provider Demographics
NPI:1639559016
Name:LUKE K. DALZELL, DDS, PLLC
Entity Type:Organization
Organization Name:LUKE K. DALZELL, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DALZELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-604-9144
Mailing Address - Street 1:5710 SIX FORKS RD
Mailing Address - Street 2:STE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8617
Mailing Address - Country:US
Mailing Address - Phone:706-604-9144
Mailing Address - Fax:
Practice Address - Street 1:5710 SIX FORKS RD
Practice Address - Street 2:STE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8617
Practice Address - Country:US
Practice Address - Phone:706-604-9144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9892261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental