Provider Demographics
NPI:1427124676
Name:CHARLES LUCHEY, MICHELLE JUDITH-MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:JUDITH-MARIE
Last Name:CHARLES LUCHEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:JUDITH-MARIE
Other - Last Name:LUCHEY CHARLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:544 N SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3326
Mailing Address - Country:US
Mailing Address - Phone:407-277-7500
Mailing Address - Fax:407-277-4713
Practice Address - Street 1:544 N SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3326
Practice Address - Country:US
Practice Address - Phone:407-277-7500
Practice Address - Fax:407-277-4713
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14237122300000X
FL0315737001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071423200Medicaid