# KEVIN C. LUCKY DDS PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235258757
- **Authorized official:** DR. KEVIN CHARLIE LUCKY DDS (OWNER)
- **Authorized official phone:** (304) 872-3919

## Contact information

- **Practice address:** 1110 JOHNSTOWN ROAD, BECKLEY, WV 25801
- **Practice address phone:** (304) 255-0717
- **Practice address fax:** (304) 255-0956
- **Mailing address:** 832 BROAD STREET, SUMMERSVILLE, WV 26651
- **Mailing address phone:** (304) 872-3919
- **Mailing address fax:** (304) 872-4043

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/28/2007
- **Last updated:** 08/22/2020