Provider Demographics
NPI:1659946150
Name:MACKLEY, LUKE (DDS)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:MACKLEY
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 1:3641 ALLIUM DR
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-8769
Mailing Address - Country:US
Mailing Address - Phone:586-453-2576
Mailing Address - Fax:
Practice Address - Street 1:4911 W ST JOE HWY # 202
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4088
Practice Address - Country:US
Practice Address - Phone:517-321-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016008501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice