Provider Demographics
NPI:1609494095
Name:LUGO, LAURA CECILIA (DMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CECILIA
Last Name:LUGO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:CECILIA
Other - Last Name:LUGO PIZZOLANTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3062 BIRD AVE UNIT F1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4588
Mailing Address - Country:US
Mailing Address - Phone:305-988-5191
Mailing Address - Fax:
Practice Address - Street 1:18851 NE 29TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-2813
Practice Address - Country:US
Practice Address - Phone:305-682-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-11
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25174122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist