Provider Demographics
NPI:1336434612
Name:POWELL, LUKE JACKSON (DMD)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:JACKSON
Last Name:POWELL
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 1:14244 HIGHWAY 231 431 N
Mailing Address - Street 2:
Mailing Address - City:HAZEL GREEN
Mailing Address - State:AL
Mailing Address - Zip Code:35750-9402
Mailing Address - Country:US
Mailing Address - Phone:256-829-8878
Mailing Address - Fax:256-867-2122
Practice Address - Street 1:5720 1ST AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35212-2522
Practice Address - Country:US
Practice Address - Phone:205-380-9455
Practice Address - Fax:205-380-9459
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5822C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice