Individual
CHARLES JOSEAPH LUCERO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1751 N STOCKTON HILL RD, STE# A, KINGMAN, AZ 86401-6601
(928) 718-8668
(928) 718-2106
Mailing address
1751 N STOCKTON HILL RD, STE# A, KINGMAN, AZ 86401-6601
(928) 718-8668
(928) 718-2106
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4688
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
356601
ARIZONA PHYSICIANS IPA,
AZ
Enumeration date
08/02/2005
Last updated
07/08/2007
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