Provider Demographics
NPI:1659682540
Name:LUECHT, JASON L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:L
Last Name:LUECHT
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:W156N11377 PILGRIM RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3422
Mailing Address - Country:US
Mailing Address - Phone:262-251-0205
Mailing Address - Fax:
Practice Address - Street 1:W156N11377 PILGRIM RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3422
Practice Address - Country:US
Practice Address - Phone:262-251-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6531-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist