Individual
MARY ANN LUCERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2201 LOUISIANA BLVD, STE D, ALBUQUERQUE, NM 87110
(505) 883-4867
(505) 883-4007
Mailing address
2201 LOUISIANA BLVD NE, STE D, ALBUQUERQUE, NM 87110-4546
(505) 883-4867
(505) 883-4007
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD1879
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD1879
DENTAL LICENSE
NM
Enumeration date
12/27/2005
Last updated
06/06/2013
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