Provider Demographics
NPI:1124317201
Name:SHUWEN LISA LU, DDS, PLLC
Entity type:Organization
Organization Name:SHUWEN LISA LU, DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHUWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-618-0176
Mailing Address - Street 1:26239 104TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7672
Mailing Address - Country:US
Mailing Address - Phone:360-618-0176
Mailing Address - Fax:206-577-3860
Practice Address - Street 1:3325 SMOKEY POINT DR
Practice Address - Street 2:SUITE 204
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-7803
Practice Address - Country:US
Practice Address - Phone:360-618-0176
Practice Address - Fax:206-577-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000106831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty