Provider Demographics
NPI:1891968541
Name:LUCERO, MARIAN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:T
Last Name:LUCERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 HIGHWAY 60
Mailing Address - Street 2:PO BOX 124
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-3919
Mailing Address - Country:US
Mailing Address - Phone:575-835-2342
Mailing Address - Fax:575-835-2207
Practice Address - Street 1:824 HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-3919
Practice Address - Country:US
Practice Address - Phone:575-835-2342
Practice Address - Fax:575-835-2207
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM 1552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist