Provider Demographics
NPI:1265606370
Name:RODOLFO A LUCAR DDS,PROF.DENTAL CORPORATION
Entity type:Organization
Organization Name:RODOLFO A LUCAR DDS,PROF.DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUCAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-821-8329
Mailing Address - Street 1:3414 W BALL RD STE K
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3726
Mailing Address - Country:US
Mailing Address - Phone:714-821-8329
Mailing Address - Fax:
Practice Address - Street 1:3414 W BALL RD STE K
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3726
Practice Address - Country:US
Practice Address - Phone:714-821-8329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental