Provider Demographics
NPI:1144328998
Name:LUTZ, JAMES BEAUFORD (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BEAUFORD
Last Name:LUTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:BEAUFORD
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:60 N SHERIDAN
Mailing Address - Street 2:STE 7
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505
Mailing Address - Country:US
Mailing Address - Phone:580-355-2000
Mailing Address - Fax:580-351-9792
Practice Address - Street 1:60 N SHERIDAN
Practice Address - Street 2:STE 7
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:580-355-2000
Practice Address - Fax:580-351-9792
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice