Provider Demographics
NPI:1215260229
Name:DE LUCIA, PING PING H (DMD)
Entity type:Individual
Prefix:
First Name:PING PING
Middle Name:H
Last Name:DE LUCIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 41ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-5015
Mailing Address - Country:US
Mailing Address - Phone:727-215-3963
Mailing Address - Fax:
Practice Address - Street 1:6430 83RD AVE
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-1213
Practice Address - Country:US
Practice Address - Phone:727-498-8123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 187571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice