Provider Demographics
NPI:1821835968
Name:LUCE LINE FAMILY DENTAL PLLC
Entity type:Organization
Organization Name:LUCE LINE FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-583-4369
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:MN
Mailing Address - Zip Code:55395-0670
Mailing Address - Country:US
Mailing Address - Phone:320-583-4369
Mailing Address - Fax:
Practice Address - Street 1:131 MAIN AVE W
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:MN
Practice Address - Zip Code:55395-7873
Practice Address - Country:US
Practice Address - Phone:320-583-4369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental