Provider Demographics
NPI:1639289424
Name:LUCAS, ROBERT WADE (MD DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WADE
Last Name:LUCAS
Suffix:
Gender:M
Credentials:MD DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 THOMAS MORE PARKWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-578-9000
Mailing Address - Fax:589-578-9815
Practice Address - Street 1:330 THOMAS MORE PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-578-9000
Practice Address - Fax:589-578-9815
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY330361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33036OtherMEDICAL
KY7555OtherDENTAL
KY7555OtherDENTAL
KY33036OtherMEDICAL