Provider Demographics
NPI:1780738864
Name:FLUCKE & ASSOCIATES DDS PC
Entity type:Organization
Organization Name:FLUCKE & ASSOCIATES DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FLUCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-525-7373
Mailing Address - Street 1:209 NW BLUE PKWY
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1872
Mailing Address - Country:US
Mailing Address - Phone:816-525-7373
Mailing Address - Fax:801-858-7633
Practice Address - Street 1:209 NW BLUE PKWY
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1872
Practice Address - Country:US
Practice Address - Phone:816-525-7373
Practice Address - Fax:801-858-7633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO149221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty