Provider Demographics
NPI:1972283794
Name:LUC, DAVID AN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:AN
Last Name:LUC
Suffix:JR
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11822 SE FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-4049
Mailing Address - Country:US
Mailing Address - Phone:503-495-5230
Mailing Address - Fax:
Practice Address - Street 1:11211 SE 82ND AVE STE H
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97086-7641
Practice Address - Country:US
Practice Address - Phone:971-338-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist