Provider Demographics
NPI:1912025883
Name:RONALD D LUKE DDS PA
Entity Type:Organization
Organization Name:RONALD D LUKE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-772-8868
Mailing Address - Street 1:3730 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904
Mailing Address - Country:US
Mailing Address - Phone:239-772-8868
Mailing Address - Fax:239-471-7669
Practice Address - Street 1:3730 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904
Practice Address - Country:US
Practice Address - Phone:239-772-8868
Practice Address - Fax:239-471-7669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12349122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty