Provider Demographics
NPI:1316259674
Name:PATRICK, LUCAS (DMD)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:PATRICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MARBURY TERRACE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:617-959-0079
Mailing Address - Fax:
Practice Address - Street 1:3531 WASHINGTON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-524-7860
Practice Address - Fax:617-524-7861
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4196122300000X, 1223P0300X
MADN18571781223P0300X
NH045121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist