Provider Demographics
NPI:1871682500
Name:REBECCA F. LUCKE, DDS,PA
Entity Type:Organization
Organization Name:REBECCA F. LUCKE, DDS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:F
Authorized Official - Last Name:LUCKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-582-1312
Mailing Address - Street 1:615 E APPLEBY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3914
Mailing Address - Country:US
Mailing Address - Phone:479-582-1312
Mailing Address - Fax:479-582-1355
Practice Address - Street 1:615 E APPLEBY RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3914
Practice Address - Country:US
Practice Address - Phone:479-582-1312
Practice Address - Fax:479-582-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F476OtherABCBS