MEDICARE: DOUGLAS J BRAJCICH JR & JULIE LUM DMD P.C.

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	21884	MA
2	1223G0001X	General Practice Dentistry	DE 60083523	WA

General Provider Information

NPI Number	:	1659505667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS J BRAJCICH JR & JULIE LUM DMD P.C.

Provider Business Mailing Address
First Line	:	515 HWY 9 STE 102
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-8523
Country	:	US
Telephone Number	:	425-334-6912
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 HWY 9 STE 102
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-8523
Country	:	US
Telephone Number	:	425-334-6912
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DOUGLAS JAMES BRAJCICH
Credential	:	DMD
Telephone Number	:	617-448-1347

Provider Enumeration Date	:	05/05/2009
Last Update Date	:	05/05/2009

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