Mario S Lucca, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

20676 Issued in MA

Practice address

185 Dartmouth St Ste 403
Boston, MA 02116-5883

Phone

(617) 300-0345

Fax

(617) 993-6970

NPI assigned

Feb 20, 2008

Sex

Male

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2018 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466467200000",
    "number": "1497923791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 DARTMOUTH ST STE 403",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021165883",
            "telephone_number": "617-300-0345",
            "fax_number": "617-993-6970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 DARTMOUTH ST STE 403",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021165883",
            "telephone_number": "617-300-0345",
            "fax_number": "617-993-6970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCCA",
        "first_name": "MARIO",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-20",
        "last_updated": "2016-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MA",
            "license": "20676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jane Davenport Lucas, PT
• Janel Lucas, LICSW,DCSW,PHD
• Joshua Lucas
• Michele Roberta Lucas, LICSW
• Lucca Oral and Facial Surgery, LLC
• James W Luccarelli, MD
• Leslie Caroline Lucchina, M.D.
• Caroline Luce, PA-C
• Christie J Lucente, PA
• Diane Elizabeth Lucente, MS

• Oral and Maxillofacial Surgery (Dentist) in Boston, MA
• Providers in Boston, MA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2016; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.