Michael a. Luckett D.M.D. & Associates (Rivercrest), LTD.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.019835 Issued in IL

Legal business name

MICHAEL A. LUCKETT D.M.D. & ASSOCIATES (RIVERCREST), LTD.

Practice address

4839 West Calsag Rd
#310
Crestwood, IL 60445-4415

Phone

(708) 597-9055

Fax

(216) 584-1062

NPI assigned

Jan 27, 2006

Organization subpart

Yes

Parent organization

DENTALONE PARTNERS, INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael A Luckett, DMD

Title

Dentist/Owner

Phone

(708) 597-9055

Specialties & licenses 7

Addresses

Other names 1

• DentalWorks Doing business as

Part of

Network Provider Associates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481155200000",
    "number": "1174594378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860036",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55486",
            "telephone_number": "216-584-1000",
            "fax_number": "216-332-7503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4839 WEST CALSAG RD",
            "address_2": "#310",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604454415",
            "telephone_number": "708-597-9055",
            "fax_number": "216-584-1062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL A. LUCKETT D.M.D. & ASSOCIATES (RIVERCREST), LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTALONE PARTNERS, INC",
        "enumeration_date": "2006-01-27",
        "last_updated": "2016-12-08",
        "status": "A",
        "authorized_official_last_name": "LUCKETT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "708-597-9055",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.019835",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DentalWorks",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Medication Management Partners
• Richard Melton, LCSW
• Brian Mendoza, D.C.
• Mimoza Metarapi, PHARMD, BCPS, BCGP
• Metro Primary Care Associates LLC
• Midwest Physician Group LTD
• Miinedoctor, Inc.
• Maxime David Morier-Roy, OD
• Morris Esformes & Melvin Segal Etal
• Allan Nance

• General Practice Dentistry in Crestwood, IL
• Providers in Crestwood, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.