Provider Demographics
NPI:1154019669
Name:ELDEEK, LUCIEL
Entity type:Individual
Prefix:DR
First Name:LUCIEL
Middle Name:
Last Name:ELDEEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4814 WHITETAIL LN
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6529
Mailing Address - Country:US
Mailing Address - Phone:813-420-1452
Mailing Address - Fax:
Practice Address - Street 1:5231 UNIVERSITY PKWY UNIT 120
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-3009
Practice Address - Country:US
Practice Address - Phone:941-363-0458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN28887122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program