Provider Demographics
NPI:1194946103
Name:LUCE, MICHAEL SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:LUCE
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 1:2033 AIRLINE RD
Mailing Address - Street 2:SUITE H-5
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4626
Mailing Address - Country:US
Mailing Address - Phone:361-991-1234
Mailing Address - Fax:361-993-3211
Practice Address - Street 1:2033 AIRLINE RD
Practice Address - Street 2:SUITE H-5
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4626
Practice Address - Country:US
Practice Address - Phone:361-991-1234
Practice Address - Fax:361-993-3211
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist