Provider Demographics
NPI:1154765980
Name:LUCKENBILL, DANIEL B (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:LUCKENBILL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3535 PENTAGON BLVD
Mailing Address - Street 2:STE 320
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1705
Mailing Address - Country:US
Mailing Address - Phone:937-433-5309
Mailing Address - Fax:937-298-0287
Practice Address - Street 1:3535 PENTAGON BLVD
Practice Address - Street 2:STE 320
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-1705
Practice Address - Country:US
Practice Address - Phone:937-433-5309
Practice Address - Fax:937-298-0287
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2021-01-18
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Provider Licenses
StateLicense IDTaxonomies
OH35.136839207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0370542Medicaid