Provider Demographics
NPI:1558481705
Name:DOLAGARAY-LUGO, NILDA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NILDA
Middle Name:
Last Name:DOLAGARAY-LUGO
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:CALLE 4 D-13
Mailing Address - Street 2:PARQUE MONTEBELLO
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-761-0406
Mailing Address - Fax:787-761-0406
Practice Address - Street 1:IA5 AVE LOMAS VERDES
Practice Address - Street 2:ROYAL PALM
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-3133
Practice Address - Country:US
Practice Address - Phone:787-798-7340
Practice Address - Fax:787-798-6080
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist