Provider Demographics
NPI:1689631376
Name:DALZELL, LUKE (DDS)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:DALZELL
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 1:5710 SIX FORKS RD.
Mailing Address - Street 2:STE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:919-866-1989
Mailing Address - Fax:919-866-0468
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:919-866-1989
Practice Address - Fax:919-866-0468
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98921223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics