Provider Demographics
NPI:1184864209
Name:LUGO-ANDUJAR, YARITZA (DMD)
Entity Type:Individual
Prefix:
First Name:YARITZA
Middle Name:
Last Name:LUGO-ANDUJAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 240440
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-0440
Mailing Address - Country:US
Mailing Address - Phone:718-265-6200
Mailing Address - Fax:718-265-6266
Practice Address - Street 1:3375 NEPTUNE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1675
Practice Address - Country:US
Practice Address - Phone:718-265-6200
Practice Address - Fax:718-265-6266
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2015-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0542641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03168421Medicaid