Provider Demographics
NPI:1093885618
Name:LUGO, ALBERTO (DMD, PC)
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:
Last Name:LUGO
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 VETERANS PKWY
Mailing Address - Street 2:SUITE 4-A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3169
Mailing Address - Country:US
Mailing Address - Phone:706-660-1310
Mailing Address - Fax:706-660-1311
Practice Address - Street 1:6501 VETERANS PKWY
Practice Address - Street 2:SUITE 4-A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3169
Practice Address - Country:US
Practice Address - Phone:706-660-1310
Practice Address - Fax:706-660-1311
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0119531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry