Provider Demographics
NPI:1013097617
Name:LUCHTEFELD, JASON M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:LUCHTEFELD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 E MCNAB RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-9355
Mailing Address - Country:US
Mailing Address - Phone:954-785-1100
Mailing Address - Fax:
Practice Address - Street 1:572 E MCNAB RD
Practice Address - Street 2:SUITE 102
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-9355
Practice Address - Country:US
Practice Address - Phone:954-785-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 16988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist