Individual
DR. KEVIN MICHAEL LUKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1250 FOREST AVE, STE 3B, PORTLAND, ME 04103-1889
(207) 878-3480
Mailing address
1250 FOREST AVE STE 3B, PORTLAND, ME 04103-1889
(207) 878-3480
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4321
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4321
DENTAL LICENSE NUMBER
ME
Enumeration date
08/14/2013
Last updated
08/22/2013
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