Organization
KEVIN C. LUCKY DDS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN CHARLIE LUCKY DDS (OWNER)
(304) 872-3919
Entity
Organization
Contact information
Practice address
1110 JOHNSTOWN ROAD, BECKLEY, WV 25801
(304) 255-0717
(304) 255-0956
Mailing address
832 BROAD STREET, SUMMERSVILLE, WV 26651
(304) 872-3919
(304) 872-4043
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104970300
INDV. NPI
—
05
—
3810007754
—
WV
Enumeration date
03/28/2007
Last updated
08/22/2020
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