Active NPI
Kevin Michael Lukis, DDS
- General Practice Dentistry
- Portland, ME
National Provider Identifier
1215360110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4321
- Practice address
- 1250 Forest Ave
Ste 3B
Portland, ME 04103-1889 - Phone
- (207) 878-3480
- NPI assigned
- Aug 14, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4321 | ME | Primary |
Addresses
Primary practice location
1250 Forest Ave
Ste 3B
Portland, ME 04103-1889
Mailing address
1250 Forest Ave Ste 3B
Portland, ME 04103-1889
Phone (207) 878-3480
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4321 | Other | ME | DENTAL LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4321 | ME | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377129600000",
"number": "1215360110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1250 FOREST AVE STE 3B",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041031889",
"telephone_number": "207-878-3480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 FOREST AVE",
"address_2": "STE 3B",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041031889",
"telephone_number": "207-878-3480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUKIS",
"first_name": "KEVIN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-14",
"last_updated": "2013-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ME",
"license": "4321",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE NUMBER",
"identifier": "4321",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.