Provider Demographics
NPI:1154588960
Name:LUCAS, THOMAS GARY (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:GARY
Last Name:LUCAS
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 1:6211 WEST 30TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPEEDWAY
Mailing Address - State:IN
Mailing Address - Zip Code:46224-3025
Mailing Address - Country:US
Mailing Address - Phone:317-297-7475
Mailing Address - Fax:317-280-1442
Practice Address - Street 1:6211 WEST 30TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:SPEEDWAY
Practice Address - State:IN
Practice Address - Zip Code:46224-3025
Practice Address - Country:US
Practice Address - Phone:317-297-7475
Practice Address - Fax:317-280-1442
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007556122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist