1245232594 NPI number — RICHARD B. LUCZAK, DDS, MPH, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245232594 NPI number — RICHARD B. LUCZAK, DDS, MPH, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD B. LUCZAK, DDS, MPH, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245232594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4251 FM 2181
Provider Second Line Business Mailing Address:
STE 264
Provider Business Mailing Address City Name:
CORINTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76210-4220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-497-3000
Provider Business Mailing Address Fax Number:
940-497-3010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4251 FM 2181
Provider Second Line Business Practice Location Address:
STE 264
Provider Business Practice Location Address City Name:
CORINTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76210-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-497-3000
Provider Business Practice Location Address Fax Number:
940-497-3010
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LUCZAK
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
BERNARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
940-497-3000

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  19398 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 870515 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com