Provider Demographics
NPI:1154414456
Name:FRED R LUCAS DDS INC
Entity type:Organization
Organization Name:FRED R LUCAS DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-623-7397
Mailing Address - Street 1:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-0570
Mailing Address - Country:US
Mailing Address - Phone:580-623-7397
Mailing Address - Fax:580-623-4912
Practice Address - Street 1:321 N NASH
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-0570
Practice Address - Country:US
Practice Address - Phone:580-623-7397
Practice Address - Fax:580-623-4912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty