Provider Demographics
NPI:1588813398
Name:LUGO, PATRICIA TERESE (DMD)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:TERESE
Last Name: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:PO BOX 1467
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1467
Mailing Address - Country:US
Mailing Address - Phone:787-769-0137
Mailing Address - Fax:787-776-0935
Practice Address - Street 1:65TH INF AVE., LOS COLOBOS SHOPPING CENTER
Practice Address - Street 2:SUITE 202, CINEMA BUILDING
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-769-0137
Practice Address - Fax:787-776-0935
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice