Provider Demographics
NPI:1649712324
Name:LUKASHOVA, NATALIA (DPD)
Entity type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:
Last Name:LUKASHOVA
Suffix:
Gender:F
Credentials:DPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 208TH PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7884
Mailing Address - Country:US
Mailing Address - Phone:206-661-0550
Mailing Address - Fax:
Practice Address - Street 1:3226 208TH PL SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7884
Practice Address - Country:US
Practice Address - Phone:206-566-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60457526122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist