Provider Demographics
NPI:1821119173
Name:LUCCA, DONALD A JR (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:A
Last Name:LUCCA
Suffix:JR
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:99 NEW HEMPSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3631
Mailing Address - Country:US
Mailing Address - Phone:845-638-0303
Mailing Address - Fax:845-638-1003
Practice Address - Street 1:99 NEW HEMPSTEAD RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3631
Practice Address - Country:US
Practice Address - Phone:845-638-0303
Practice Address - Fax:845-638-1003
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050061122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist