Individual
MRS. KAREN BRYANT LUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1121 DELAWARE AVENUE, B, MCCOMB, MS 39648
(601) 684-3966
(601) 684-3875
Mailing address
1121 DELAWARE AVENUE, B, MCCOMB, MS 39648
(601) 684-3966
(601) 684-3875
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
266492
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660074
—
MS
01
—
1891231
MEDICAID
LA
01
—
834997
UNITED CONCORDIA
—
Enumeration date
08/22/2006
Last updated
07/08/2007
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