Collette T. Lucas, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2012017289 Issued in MO

Practice address

2751 Fountain PL
Suite 1
Wildwood, MO 63040-1202

Phone

(636) 273-9258

Fax

(636) 273-3710

NPI assigned

May 17, 2013

Last updated

May 17, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Missouri Dental Professionals, Richard Straus, DMD, PC

  dba MyWildwoodDentist.com

  • General Practice Dentistry
  • Wildwood, MO
  • NPI 1861713497
  NPD (past)

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

{
    "created_epoch": "1368748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368748800000",
    "number": "1245676295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2751 FOUNTAIN PL",
            "address_2": "SUITE 1",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630401202",
            "telephone_number": "636-273-9258",
            "fax_number": "636-273-3710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2751 FOUNTAIN PL",
            "address_2": "SUITE 1",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630401202",
            "telephone_number": "636-273-9258",
            "fax_number": "636-273-3710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCAS",
        "first_name": "COLLETTE",
        "middle_name": "T.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-17",
        "last_updated": "2013-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2012017289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven R. Lawless, D.C.
• Amanda N Lawrence, PA-C
• Jana Leabig
• Leo Warren MD PC
• LH Chiropractic LLC
• Rachael Grace Macgregor, DPT, DMT, FAAOMPT
• Elicia Malak, PHARMD
• Jessica Mathews, MA, MS
• Dawn Maurer, PLPC
• Ingrid McCarty, MSW,LCSW

• Dentist in Wildwood, MO
• Providers in Wildwood, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.