MEDICARE: DR. LUCY WEN DMD

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	1223G0001X	General Practice Dentistry	12014527A	IN

General Provider Information

NPI Number	:	1295573665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCY WEN DMD

Provider Business Mailing Address
First Line	:	2000 VETERANS MEMORIAL PKWY S
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-9183
Country	:	US
Telephone Number	:	765-746-6166
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 VETERANS MEMORIAL PKWY S
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-9183
Country	:	US
Telephone Number	:	765-746-6166
Fax Number	:

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

Provider Enumeration Date	:	07/18/2024
Last Update Date	:	07/18/2024

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