Provider Demographics
NPI:1750959987
Name:MATHES, LUCAS PETER (DDS)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:PETER
Last Name:MATHES
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 1:15024 LYONS ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3958
Mailing Address - Country:US
Mailing Address - Phone:248-974-8779
Mailing Address - Fax:
Practice Address - Street 1:15024 LYONS ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3958
Practice Address - Country:US
Practice Address - Phone:248-974-8779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist