Provider Demographics
NPI:1932289865
Name:LUCAS, MARK C (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:LUCAS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7864 S ULSTER ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3334
Mailing Address - Country:US
Mailing Address - Phone:303-790-9507
Mailing Address - Fax:
Practice Address - Street 1:10461 PARK MEADOWS DR
Practice Address - Street 2:#101
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5306
Practice Address - Country:US
Practice Address - Phone:303-534-2626
Practice Address - Fax:303-708-1350
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO82191223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99150042Medicaid