Provider Demographics
NPI:1093935587
Name:LUJAN, EILEEN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:M
Last Name:LUJAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1040
Mailing Address - Country:US
Mailing Address - Phone:305-448-4433
Mailing Address - Fax:305-441-2821
Practice Address - Street 1:45 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1040
Practice Address - Country:US
Practice Address - Phone:305-448-4433
Practice Address - Fax:305-441-2821
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN140491223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN14049OtherDENTAL LICENSE