Provider Demographics
NPI:1851670947
Name:ROGER W. LUCAS DDS, P.S.
Entity Type:Organization
Organization Name:ROGER W. LUCAS DDS, P.S.
Other - Org Name:LYNNWOOD KIDS DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-774-1285
Mailing Address - Street 1:18833 28TH AVE W
Mailing Address - Street 2:SUITE B
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4714
Mailing Address - Country:US
Mailing Address - Phone:425-774-1285
Mailing Address - Fax:425-774-1822
Practice Address - Street 1:18833 28TH AVE W
Practice Address - Street 2:SUITE B
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4714
Practice Address - Country:US
Practice Address - Phone:425-774-1285
Practice Address - Fax:425-774-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00011254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty