Individual
MR. KELLY W LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2 SCHOOL HOUSE RD, NAKNEK, AK 99633
(907) 357-5214
(907) 357-5213
Mailing address
3161 E PALMER-WASILLA HWY, REGAN BLDG SU 5, WASILLA, AK 99654-7271
(907) 357-5214
(907) 357-5213
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
AA673
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DD0673
—
AK
Enumeration date
05/01/2007
Last updated
07/08/2007
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