Provider Demographics
NPI:1255070447
Name:ARCHER, LUKE WILLIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:WILLIAM
Last Name:ARCHER
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 1:801 E 170TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3414
Mailing Address - Country:US
Mailing Address - Phone:708-712-6307
Mailing Address - Fax:
Practice Address - Street 1:17653 TORRENCE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-4839
Practice Address - Country:US
Practice Address - Phone:708-418-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033666122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist