Provider Demographics
NPI:1457889685
Name:LUCERO, JACQUELINE ANDREA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ANDREA
Last Name:LUCERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2823
Mailing Address - Country:US
Mailing Address - Phone:781-405-1879
Mailing Address - Fax:
Practice Address - Street 1:495 MAIN ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-4253
Practice Address - Country:US
Practice Address - Phone:978-449-9919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18575801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice