Provider Demographics
NPI:1669493326
Name:LUKASIK, ANTOINETTE A (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:A
Last Name:LUKASIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:A
Other - Last Name:LUKASIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:85 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063
Mailing Address - Country:US
Mailing Address - Phone:716-672-2854
Mailing Address - Fax:716-672-5269
Practice Address - Street 1:85 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063
Practice Address - Country:US
Practice Address - Phone:716-672-2854
Practice Address - Fax:716-672-5269
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY456561122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01549233Medicaid