Provider Demographics
NPI:1265493480
Name:PAGAN-LUGO, JORGE G
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:G
Last Name:PAGAN-LUGO
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:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0753
Mailing Address - Country:US
Mailing Address - Phone:787-892-1029
Mailing Address - Fax:787-892-1029
Practice Address - Street 1:36 CALLE RUIZ BELVIS
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4009
Practice Address - Country:US
Practice Address - Phone:787-892-1029
Practice Address - Fax:787-892-1029
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist