Organization
LUCE TOOTH PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY RENEE LUCE DMD (OWNER/DENTIST)
(727) 656-7145
Entity
Organization
Contact information
Practice address
8500 113TH ST STE B, SEMINOLE, FL 33772-4126
(727) 390-0037
Mailing address
4641 SHORT LEAF LN NE, SAINT PETERSBURG, FL 33703-3147
(804) 519-7795
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN18737
FLORIDA BOARD OF DENTISTRY
FL
01
—
DN21100
FLORIDA BOARD OF DENTISTRY
FL
Enumeration date
08/23/2022
Last updated
08/23/2022
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