MEDICARE: DR. CONSTANT E. LU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7444	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932217247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONSTANT E. LU DDS

Provider Business Mailing Address
First Line	:	400 N STONEGATE DR
Second Line	:
City	:	WASHOUGAL
State	:	WA
Zip	:	98671-8587
Country	:	US
Telephone Number	:	360-844-5616
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 NE 78TH ST
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98665-0697
Country	:	US
Telephone Number	:	360-576-3570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2006
Last Update Date	:	01/22/2014

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