MEDICARE: CONSTANT LU DDS, PC.

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	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	:	1629196217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSTANT LU DDS, PC.

Provider Business Mailing Address
First Line	:	3205 NE 78TH ST
Second Line	:	SUITE 11
City	:	VANCOUVER
State	:	WA
Zip	:	98665-0697
Country	:	US
Telephone Number	:	360-576-3570
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 NE 78TH ST
Second Line	:	SUITE 11
City	:	VANCOUVER
State	:	WA
Zip	:	98665-0697
Country	:	US
Telephone Number	:	360-576-3570
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CONSTANT E. LU
Credential	:	DDS
Telephone Number	:	360-576-3570

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	01/22/2014

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