Provider Demographics
NPI:1730926874
Name:LUCE LINE FAMILY DENTAL PLLC
Entity type:Organization
Organization Name:LUCE LINE FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-583-4369
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:HOWARD LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55349-0664
Mailing Address - Country:US
Mailing Address - Phone:320-583-4369
Mailing Address - Fax:
Practice Address - Street 1:612 8TH AVE
Practice Address - Street 2:
Practice Address - City:HOWARD LAKE
Practice Address - State:MN
Practice Address - Zip Code:55349-5148
Practice Address - Country:US
Practice Address - Phone:320-583-4369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUCE LINE FAMILY DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental