Provider Demographics
NPI:1740834852
Name:FACER, LUKE AVERETT (DDS)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:AVERETT
Last Name:FACER
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 1:27012 FLORESTA LN
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5203
Mailing Address - Country:US
Mailing Address - Phone:949-422-3217
Mailing Address - Fax:
Practice Address - Street 1:14415 CULVER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0305
Practice Address - Country:US
Practice Address - Phone:949-733-0486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60975999122300000X
CA1056811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist