Individual
DR. KATHLEEN MARIE LUCKING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
5400 CORACI BLVD APT 6102, PORT ORANGE, FL 32128-7576
(989) 708-1384
Mailing address
5400 CORACI BLVD APT 6102, PORT ORANGE, FL 32128-7576
(989) 708-1384
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019029445
IL
122300000X
Dentist
Primary
DN24377
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14430849
—
FL
Enumeration date
06/11/2013
Last updated
08/27/2021
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