Provider Demographics
NPI:1669664066
Name:LUKE, JOSEPH THACHARA (DDS; MS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:THACHARA
Last Name:LUKE
Suffix:
Gender:M
Credentials:DDS; MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:26220 POINT LOOKOUT ROAD
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-0477
Mailing Address - Country:US
Mailing Address - Phone:301-475-8100
Mailing Address - Fax:301-475-3848
Practice Address - Street 1:26220 POINT LOOKOUT ROAD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-0477
Practice Address - Country:US
Practice Address - Phone:301-475-8100
Practice Address - Fax:301-475-3848
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106251223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics