Healthcare Provider Details

I. General information

NPI: 1003923350
Provider Name (Legal Business Name): VIRGINIA M LUJAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N TRIBAL CENTER RD
SKOKOMISH NATION WA
98584-9748
US

IV. Provider business mailing address

1115 N TACOMA AVE
TACOMA WA
98403-2930
US

V. Phone/Fax

Practice location:
  • Phone: 360-426-5755
  • Fax: 360-426-5755
Mailing address:
  • Phone: 253-228-4429
  • Fax: 253-228-4429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00007150
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: