NPIMap

Organization Active NPI

Kevin C. Lucky DDS PLLC

  • Dental Clinic/Center
  • Beckley, WV
National Provider Identifier
1235258757
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
KEVIN C. LUCKY DDS PLLC
Practice address
1110 Johnstown Road
Beckley, WV 25801
Phone
(304) 255-0717
Fax
(304) 255-0956
NPI assigned
Mar 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Kevin Charlie Lucky, DDSNPI 1104970300
Title
Owner
Phone
(304) 872-3919

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1110 Johnstown Road
Beckley, WV 25801

Mailing address

832 Broad Street
Summersville, WV 26651
Phone (304) 872-3919

Other identifiers 2

IdentifierTypeStateIssuer
1104970300OtherINDV. NPI
3810007754MedicaidWV

National Provider Directory

National Provider Directory

Locations

1110 Johnstown Rd
Beckley, WV 25801
Phone (304) 255-0717

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235258757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "832 BROAD STREET",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "26651",
            "telephone_number": "304-872-3919",
            "fax_number": "304-872-4043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 JOHNSTOWN ROAD",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "25801",
            "telephone_number": "304-255-0717",
            "fax_number": "304-255-0956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN C. LUCKY DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LUCKY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "CHARLIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-872-3919",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDV. NPI",
            "identifier": "1104970300",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810007754",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beckley, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.