Provider Demographics
NPI:1497327951
Name:LUJAN, KEVIN DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DANIEL
Last Name:LUJAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 W FLAGLER ST STE 201B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2052
Mailing Address - Country:US
Mailing Address - Phone:305-480-8353
Mailing Address - Fax:
Practice Address - Street 1:8500 W FLAGLER ST STE 201B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2052
Practice Address - Country:US
Practice Address - Phone:305-480-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty