Provider Demographics
NPI:1700388014
Name:VICKERS, LUKE DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:DAVID
Last Name:VICKERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3401
Mailing Address - Country:US
Mailing Address - Phone:760-466-3993
Mailing Address - Fax:
Practice Address - Street 1:839 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3401
Practice Address - Country:US
Practice Address - Phone:760-466-3993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL018.0020731223S0112X
HIDT-29601223S0112X
390200000X
CA1035241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program