Provider Demographics
NPI:1770613754
Name:LUCAS, CLEOKA ALESHA (DDS)
Entity type:Individual
Prefix:DR
First Name:CLEOKA
Middle Name:ALESHA
Last Name:LUCAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CLEOKA
Other - Middle Name:ALESHA
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:15848 ARABIAN MEWS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-8796
Mailing Address - Country:US
Mailing Address - Phone:904-710-0962
Mailing Address - Fax:
Practice Address - Street 1:181 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2525
Practice Address - Country:US
Practice Address - Phone:704-459-3476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35931223P0221X
GADN0132951223P0221X
NC89161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9184392Medicaid
GA101050Medicaid
NC5915302Medicaid
GA633874403AMedicaid