Provider Demographics
NPI:1386769792
Name:LUCAS ORTHODONITCS, LTD.
Entity type:Organization
Organization Name:LUCAS ORTHODONITCS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-651-7124
Mailing Address - Street 1:1401 MCHENRY RD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1382
Mailing Address - Country:US
Mailing Address - Phone:847-459-7124
Mailing Address - Fax:847-459-7138
Practice Address - Street 1:1401 MCHENRY RD
Practice Address - Street 2:SUITE 221
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1382
Practice Address - Country:US
Practice Address - Phone:847-459-7124
Practice Address - Fax:847-459-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty