Provider Demographics
NPI:1144578048
Name:DE LUCA, LINDA DIANE PAULETTE (DDS)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:DIANE PAULETTE
Last Name:DE LUCA
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 1:700 BROADWAY STE 64
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1674
Mailing Address - Country:US
Mailing Address - Phone:201-666-1300
Mailing Address - Fax:201-666-2055
Practice Address - Street 1:700 BROADWAY STE 64
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1674
Practice Address - Country:US
Practice Address - Phone:201-666-1300
Practice Address - Fax:210-666-2055
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102121900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist