Provider Demographics
NPI:1447524178
Name:LUEKENGA DENTAL PLLC
Entity type:Organization
Organization Name:LUEKENGA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MEADOR
Authorized Official - Last Name:LUEKENGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:979-865-3668
Mailing Address - Street 1:12 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77418-1440
Mailing Address - Country:US
Mailing Address - Phone:979-865-3668
Mailing Address - Fax:979-865-8583
Practice Address - Street 1:12 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:TX
Practice Address - Zip Code:77418-1440
Practice Address - Country:US
Practice Address - Phone:979-865-3668
Practice Address - Fax:979-865-8583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty