Provider Demographics
NPI:1316225337
Name:LUGO HART, VANESSA (DDS)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:LUGO HART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 NETHERLAND AVE APT 2012
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4819
Mailing Address - Country:US
Mailing Address - Phone:917-690-8612
Mailing Address - Fax:
Practice Address - Street 1:232 W 61ST STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7803
Practice Address - Country:US
Practice Address - Phone:646-558-6058
Practice Address - Fax:646-558-6059
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0555511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry