Provider Demographics
NPI:1487907176
Name:LUIKHAM, VICTOR (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:LUIKHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 N VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3216
Mailing Address - Country:US
Mailing Address - Phone:956-783-7070
Mailing Address - Fax:
Practice Address - Street 1:1618 N VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3216
Practice Address - Country:US
Practice Address - Phone:956-783-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX285041223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics