Provider Demographics
NPI:1447711924
Name:LUTGEN, PAUL JOSEPH
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOSEPH
Last Name:LUTGEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19625 68TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5909
Mailing Address - Country:US
Mailing Address - Phone:425-778-5991
Mailing Address - Fax:
Practice Address - Street 1:19625 68TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5909
Practice Address - Country:US
Practice Address - Phone:425-778-5991
Practice Address - Fax:425-778-5910
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA609770651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery