Provider Demographics
NPI:1114736014
Name:LUCENA, AUSTEN LUCENA JOSEPH
Entity type:Individual
Prefix:DR
First Name:AUSTEN LUCENA
Middle Name:JOSEPH
Last Name:LUCENA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9339 LA ROSE CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CA
Mailing Address - Zip Code:95938-9529
Mailing Address - Country:US
Mailing Address - Phone:530-520-5025
Mailing Address - Fax:
Practice Address - Street 1:2310 E BIDWELL ST STE 150
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3586
Practice Address - Country:US
Practice Address - Phone:916-983-7700
Practice Address - Fax:916-983-7981
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1114441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty