Provider Demographics
NPI:1053605725
Name:MEYER, LUCAS J (DMD)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:J
Last Name:MEYER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16599 HUNTERS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1734
Mailing Address - Country:US
Mailing Address - Phone:314-856-8936
Mailing Address - Fax:
Practice Address - Street 1:16599 HUNTERS CROSSING DR
Practice Address - Street 2:
Practice Address - City:GROVER
Practice Address - State:MO
Practice Address - Zip Code:63040-1734
Practice Address - Country:US
Practice Address - Phone:314-856-8936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080171451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice