Provider Demographics
NPI:1942561196
Name:LUCIO, RICARDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:LUCIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-7612
Mailing Address - Country:US
Mailing Address - Phone:979-245-4746
Mailing Address - Fax:979-244-4746
Practice Address - Street 1:4040 AVENUE F
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-7612
Practice Address - Country:US
Practice Address - Phone:979-245-4746
Practice Address - Fax:979-244-4746
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice