Provider Demographics
NPI:1386768505
Name:LUFT, RICK CONRAD (DDS)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:CONRAD
Last Name:LUFT
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 1:8639 BISON RD
Mailing Address - Street 2:
Mailing Address - City:LARSEN
Mailing Address - State:WI
Mailing Address - Zip Code:54947-9568
Mailing Address - Country:US
Mailing Address - Phone:920-836-2520
Mailing Address - Fax:920-836-3057
Practice Address - Street 1:618 S GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3154
Practice Address - Country:US
Practice Address - Phone:920-722-5151
Practice Address - Fax:920-886-9443
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001635G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice