Provider Demographics
NPI:1992092415
Name:LUCARELLI, ANNIKA LINDGREN (DDS)
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:LINDGREN
Last Name:LUCARELLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2575
Mailing Address - Country:US
Mailing Address - Phone:301-938-0169
Mailing Address - Fax:
Practice Address - Street 1:76 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2575
Practice Address - Country:US
Practice Address - Phone:732-246-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02581000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist