Individual
TRISTAN GRANT LUCKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1110 JOHNSTOWN RD, BECKLEY, WV 25801-4942
(304) 255-0717
Mailing address
832 BROAD ST, SUMMERSVILLE, WV 26651-1758
(304) 644-5382
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4872
WV
Other
Enumeration date
06/22/2026
Last updated
06/22/2026
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