Provider Demographics
NPI:1194840017
Name:LUC, MAYLENE (DDS)
Entity type:Individual
Prefix:
First Name:MAYLENE
Middle Name:
Last Name:LUC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 JEFFERSON BLVD
Mailing Address - Street 2:STE. 7
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3343
Mailing Address - Country:US
Mailing Address - Phone:916-371-9051
Mailing Address - Fax:916-371-9095
Practice Address - Street 1:1035 JEFFERSON BLVD
Practice Address - Street 2:STE. 7
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3343
Practice Address - Country:US
Practice Address - Phone:916-371-9051
Practice Address - Fax:916-371-9095
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51569122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist