Provider Demographics
NPI:1689801433
Name:BOE, LUCAS S (DMD)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:S
Last Name:BOE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1013 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2302
Mailing Address - Country:US
Mailing Address - Phone:319-260-2077
Mailing Address - Fax:319-260-2078
Practice Address - Street 1:1013 HUDSON RD
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2302
Practice Address - Country:US
Practice Address - Phone:319-260-2077
Practice Address - Fax:319-260-2078
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA086001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics