Provider Demographics
NPI:1003923350
Name:LUJAN, VIRGINIA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:M
Last Name:LUJAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 N TACOMA AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2930
Mailing Address - Country:US
Mailing Address - Phone:253-228-4429
Mailing Address - Fax:253-228-4429
Practice Address - Street 1:100 N TRIBAL CENTER RD
Practice Address - Street 2:
Practice Address - City:SKOKOMISH NATION
Practice Address - State:WA
Practice Address - Zip Code:98584-9748
Practice Address - Country:US
Practice Address - Phone:360-426-5755
Practice Address - Fax:360-426-5755
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000071501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5022769Medicaid