Provider Demographics
NPI:1487640793
Name:LUGO-MATIAS, EDWIN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:S
Last Name:LUGO-MATIAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 565
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0565
Mailing Address - Country:US
Mailing Address - Phone:787-837-8346
Mailing Address - Fax:787-580-7184
Practice Address - Street 1:PR 149, KM 62.4
Practice Address - Street 2:GUAYABAL PROFESSIONAL BLDG., SUITE 2002
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-9519
Practice Address - Country:US
Practice Address - Phone:787-837-8346
Practice Address - Fax:787-580-7184
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice