Provider Demographics
NPI:1427254812
Name:LUIKENS, MICHELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:LUIKENS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3209
Mailing Address - Country:US
Mailing Address - Phone:575-627-0141
Mailing Address - Fax:
Practice Address - Street 1:31 GAIL HARRIS ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-8190
Practice Address - Country:US
Practice Address - Phone:575-347-3462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDRES202007122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist