Provider Demographics
NPI:1295128155
Name:LUIKHAM DENTAL PLLC
Entity type:Organization
Organization Name:LUIKHAM DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:LUIKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-583-1000
Mailing Address - Street 1:2605 W MILE 5 RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-0968
Mailing Address - Country:US
Mailing Address - Phone:956-583-1000
Mailing Address - Fax:956-583-8000
Practice Address - Street 1:2605 W MILE 5 RD STE 1
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-0968
Practice Address - Country:US
Practice Address - Phone:956-583-1000
Practice Address - Fax:956-583-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX264201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX294738401Medicaid