Provider Demographics
NPI:1720292873
Name:LUCAS, PETER H (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:H
Last Name:LUCAS
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 1:9 WINEBERRY CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ARM
Mailing Address - State:MD
Mailing Address - Zip Code:21057-9138
Mailing Address - Country:US
Mailing Address - Phone:410-882-9025
Mailing Address - Fax:
Practice Address - Street 1:515 E JOPPA RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5418
Practice Address - Country:US
Practice Address - Phone:410-321-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD69121223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics