Provider Demographics
NPI:1245683804
Name:LUKAVSKY, MICHAEL E (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:LUKAVSKY
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:NM-571
Mailing Address - Street 2:#28
Mailing Address - City:EL RITO
Mailing Address - State:NM
Mailing Address - Zip Code:87530
Mailing Address - Country:US
Mailing Address - Phone:575-581-0028
Mailing Address - Fax:575-581-4592
Practice Address - Street 1:NM-571
Practice Address - Street 2:#28
Practice Address - City:EL RITO
Practice Address - State:NM
Practice Address - Zip Code:87530
Practice Address - Country:US
Practice Address - Phone:575-581-0028
Practice Address - Fax:575-581-4592
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0095561223G0001X
NM47781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice