Individual
COLLETTE T. LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2751 FOUNTAIN PL, SUITE 1, WILDWOOD, MO 63040-1202
(636) 273-9258
(636) 273-3710
Mailing address
2751 FOUNTAIN PL, SUITE 1, WILDWOOD, MO 63040-1202
(636) 273-9258
(636) 273-3710
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2012017289
MO
Other
Enumeration date
05/17/2013
Last updated
05/17/2013
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