Provider Demographics
NPI:1548989569
Name:LUCE TOOTH PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:LUCE TOOTH PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LUCE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-656-7145
Mailing Address - Street 1:4641 SHORT LEAF LN NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3147
Mailing Address - Country:US
Mailing Address - Phone:804-519-7795
Mailing Address - Fax:
Practice Address - Street 1:8500 113TH ST STE B
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4126
Practice Address - Country:US
Practice Address - Phone:727-390-0037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN18737OtherFLORIDA BOARD OF DENTISTRY
FLDN21100OtherFLORIDA BOARD OF DENTISTRY