Provider Demographics
NPI:1477766061
Name:LUECKE, PERCY EDGAR III (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:PERCY
Middle Name:EDGAR
Last Name:LUECKE
Suffix:III
Gender:M
Credentials:DDS, MSD
Other - Prefix:DR
Other - First Name:PERCY
Other - Middle Name:EDGAR
Other - Last Name:LUECKE
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:DDS MSD
Mailing Address - Street 1:4902 GOLDEN QUAIL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1636
Mailing Address - Country:US
Mailing Address - Phone:210-690-0662
Mailing Address - Fax:210-696-8742
Practice Address - Street 1:4902 GOLDEN QUAIL
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1636
Practice Address - Country:US
Practice Address - Phone:210-690-0662
Practice Address - Fax:210-696-8742
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics