Provider Demographics
NPI:1760974554
Name:LUTES, MEAGHAN MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEAGHAN
Middle Name:MARIE
Last Name:LUTES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 S US 301
Mailing Address - Street 2:
Mailing Address - City:SUMTERVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:33585-5141
Mailing Address - Country:US
Mailing Address - Phone:352-793-5900
Mailing Address - Fax:352-793-6269
Practice Address - Street 1:314 S LINE AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4606
Practice Address - Country:US
Practice Address - Phone:352-793-5900
Practice Address - Fax:352-793-6269
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist