| Kevin C. Lucky Dds Pllc | |
|
1110 Johnstown Road Beckley WV 25801 | |
| (304) 255-0717 | |
| (304) 255-0956 |
| Full Name | Kevin C. Lucky Dds Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1110 Johnstown Road, Beckley, West Virginia |
| Authorized Official Name and Position | Kevin Charlie Lucky (OWNER) |
| Authorized Official Contact | 3048723919 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kevin C. Lucky Dds Pllc 832 Broad Street Summersville WV 26651 Ph: (304) 872-3919 | Kevin C. Lucky Dds Pllc 1110 Johnstown Road Beckley WV 25801 Ph: (304) 255-0717 |
| NPI Number | 1235258757 |
|---|---|
| Provider Enumeration Date | 03/28/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235258757 | NPI | - | NPPES |
| 1104970300 | Other | INDV. NPI | |
| 3810007754 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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