Kelli R Lucia, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

12009481 Issued in IN

Practice address

6443 W 10TH St Ste 204
Indianapolis, IN 46214-6502

Phone

(317) 754-8486

NPI assigned

Nov 21, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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

State licenses

Practice roles

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

• James a. Weddell DDS,MSD,PC

  • Pediatric Dentistry
  • Indianapolis, IN
  • NPI 1881769602
  NPD (past)

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1811062664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7805 TIMBER RUN LN STE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462564734",
            "telephone_number": "317-213-3403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6443 W 10TH ST STE 204",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462146502",
            "telephone_number": "317-754-8486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCIA",
        "first_name": "KELLI",
        "middle_name": "R",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12009481",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100199300",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jayd Lucco, MS, BCBA
• Kara Lucero
• Richard Lucht, MD
• Allegra Lucia, A.T.C.
• John P Lucia, M.D.
• Marcella Lucia
• Michelle Lee Lucia, MD
• Lucid Soul Wellness
• Lucilles House of Companion
• Lucina Treatment Center, LLC

• Pediatric Dentistry in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Pediatric Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2024; 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.