Provider Demographics
NPI:1972843670
Name:LUCAS, LESLIE A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:A
Last Name:LUCAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 RIVERSIDE BOULEVARD
Mailing Address - Street 2:# 5 J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069
Mailing Address - Country:US
Mailing Address - Phone:212-712-9492
Mailing Address - Fax:
Practice Address - Street 1:120 RIVERSIDE BOULEVARD
Practice Address - Street 2:# 5 J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10069
Practice Address - Country:US
Practice Address - Phone:212-712-9492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042723122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist