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Provider Information for 1407971666



DR. WAYNE A LUCO DDS

Gender: MALE

Individual NPI: 1407971666

Calendar   Last Updated:  2007-07-08
  Certification Date: 

Details

Name Value
NPI 1407971666
Enumeration Date 2007-03-20
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 4405 JAGER DR NE C-1
RIO RANCHO, NM 87144-5709
United States

Phone: 505-867-1442 | Fax:
View Map External Link
Primary Practice Address 4405 JAGER DR NE C-1
RIO RANCHO, NM 87144-5709
United States

Phone: 505-867-1442 | Fax: 505-867-1438
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice NM 2424