Provider Demographics
NPI:1174253553
Name:PAUL J. LUND, MPH, DDS, MSD, CHARTERED
Entity Type:Organization
Organization Name:PAUL J. LUND, MPH, DDS, MSD, CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-335-5700
Mailing Address - Street 1:1206 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2454
Mailing Address - Country:US
Mailing Address - Phone:425-335-5700
Mailing Address - Fax:
Practice Address - Street 1:16820 SMOKEY POINT BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8458
Practice Address - Country:US
Practice Address - Phone:425-335-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1223X0400XOtherORTHODONTIST