Provider Demographics
NPI:1902112832
Name:LUCE, NATALIE (DDS)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:LUCE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 W CRYSTAL LAKE RD STE H
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4250
Mailing Address - Country:US
Mailing Address - Phone:815-385-1570
Mailing Address - Fax:
Practice Address - Street 1:4318 W CRYSTAL LAKE RD STE H
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4250
Practice Address - Country:US
Practice Address - Phone:815-385-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210020821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics