Provider Demographics
NPI:1992898654
Name:LUKACS, JAMES M
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:LUKACS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:M
Other - Last Name:LUKACS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:7405 W GRANDRIDGE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6708
Mailing Address - Country:US
Mailing Address - Phone:509-783-8161
Mailing Address - Fax:509-783-0327
Practice Address - Street 1:7405 W GRANDRIDGE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6708
Practice Address - Country:US
Practice Address - Phone:509-783-8161
Practice Address - Fax:509-783-0327
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA58511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5079504Medicaid
WA5581OtherLICENSE