Provider Demographics
NPI:1871758425
Name:WINDER, LUCAS (DDS)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:
Last Name:WINDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-4500
Mailing Address - Country:US
Mailing Address - Phone:515-961-0534
Mailing Address - Fax:
Practice Address - Street 1:2000 N 4TH ST
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-4500
Practice Address - Country:US
Practice Address - Phone:515-961-0534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08797122300000X
ORD9164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist