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Contact Information

KEVIN C LUCKY, DDS
832 BROAD STREET
SUMMERSVILLE, WV26651
 Phone: 304-872-3919
 Fax: 304-872-4943
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for KEVIN C LUCKY · (Male)

NPI # 1104970300
Status Active
Credentials DDS (Doctor of Dental Surgery)
Entity Individual
Enumeration date 01/23/2007
Last updated 08/03/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • WV License # 3293
  • WV Medicaid 0134684000
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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