Basic Information
Provider Information | |||||||||
NPI: | 1912568031 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LUCE | ||||||||
FirstName: | SCHULER | ||||||||
MiddleName: | PRESTON | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DDS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 9900 LINCOLN STREET, 2ND FLOOR, ATTN: CREDENTIAL OFFICE | ||||||||
Address2: | US ARMY DENTAC | ||||||||
City: | TACOMA | ||||||||
State: | WA | ||||||||
PostalCode: | 98327 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2539684079 | ||||||||
FaxNumber: | 2539685919 | ||||||||
Practice Location | |||||||||
Address1: | US ARMY DENTAC | ||||||||
Address2: | 9900 LINCOLN STREET, 2ND FLOOR | ||||||||
City: | TACOMA | ||||||||
State: | WA | ||||||||
PostalCode: | 98327 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2539684079 | ||||||||
FaxNumber: | 2539685919 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/28/2019 | ||||||||
LastUpdateDate: | 06/28/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 11351660-9922 | UT | Y |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   |
No ID Information.