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Individual

STEPHANIE N LUCKETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
2215 PORTLAND AVE, LOUISVILLE, KY 40212-1033
(502) 772-8160
(502) 772-8108
Mailing address
2215 PORTLAND AVENUE, LOUISVILLE, KY 40242-3214
(502) 772-8160
(502) 772-8108

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9477
KY

Other

Enumeration date
07/24/2014
Last updated
08/06/2016
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