Provider Demographics
NPI:1982330767
Name:GALAN, LYDIA TRUJILLO (EPDH)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:TRUJILLO
Last Name:GALAN
Suffix:
Gender:F
Credentials:EPDH
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:GALAN-LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EPDH
Mailing Address - Street 1:130 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:METOLIUS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-2310
Mailing Address - Country:US
Mailing Address - Phone:541-460-2002
Mailing Address - Fax:
Practice Address - Street 1:212 SW 4TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1322
Practice Address - Country:US
Practice Address - Phone:971-383-0948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH8421124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist