Individual
JEROME M LUKASIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7117 GREEN BAY RD, KENOSHA, WI 53142-1450
(262) 942-7000
(262) 942-7117
Mailing address
7117 GREEN BAY RD, KENOSHA, WI 53142-1450
(262) 942-7000
(262) 942-7117
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4992-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33749100
—
WI
Enumeration date
08/29/2006
Last updated
07/08/2007
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