Provider Demographics
NPI:1245232594
Name:RICHARD B. LUCZAK, DDS, MPH, PA
Entity type:Organization
Organization Name:RICHARD B. LUCZAK, DDS, MPH, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:LUCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPH
Authorized Official - Phone:940-497-3000
Mailing Address - Street 1:4251 FM 2181
Mailing Address - Street 2:STE 264
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-4220
Mailing Address - Country:US
Mailing Address - Phone:940-497-3000
Mailing Address - Fax:940-497-3010
Practice Address - Street 1:4251 FM 2181
Practice Address - Street 2:STE 264
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-4220
Practice Address - Country:US
Practice Address - Phone:940-497-3000
Practice Address - Fax:940-497-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
870515OtherUNITED CONCORDIA