Provider Demographics
NPI:1154643658
Name:LUCERO, TONI JON (DDS)
Entity type:Individual
Prefix:DR
First Name:TONI
Middle Name:JON
Last Name:LUCERO
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:1855 AUSTIN BLUFFS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918
Mailing Address - Country:US
Mailing Address - Phone:719-502-9016
Mailing Address - Fax:719-000-0000
Practice Address - Street 1:1855 AUSTIN BLUFFS PARKWAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918
Practice Address - Country:US
Practice Address - Phone:719-599-5980
Practice Address - Fax:719-599-0691
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO72901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO850823964OtherDR TONI J LUCERO DDS LLC
CO02072908Medicaid