Provider Demographics
NPI:1699028456
Name:LUCIDA DENTAL PLLC
Entity Type:Organization
Organization Name:LUCIDA DENTAL PLLC
Other - Org Name:OCEANO DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENAYAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ASTANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-831-5173
Mailing Address - Street 1:2887 S RICHEY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77017-7215
Mailing Address - Country:US
Mailing Address - Phone:832-831-5173
Mailing Address - Fax:
Practice Address - Street 1:2887 S RICHEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-7215
Practice Address - Country:US
Practice Address - Phone:831-831-5173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty