Provider Demographics
NPI:1922999713
Name:LUCAS, BETHANY MICHELLE (RDH)
Entity type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:MICHELLE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21110 VIKING AVE NW APT 318
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-0380
Mailing Address - Country:US
Mailing Address - Phone:360-508-5909
Mailing Address - Fax:
Practice Address - Street 1:19705 VIKING AVE NW STE 201
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8351
Practice Address - Country:US
Practice Address - Phone:360-377-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA70024272124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist