Provider Demographics
NPI:1790787695
Name:LUGAKINGIRA, MULOKOZI K (DMD, DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MULOKOZI
Middle Name:K
Last Name:LUGAKINGIRA
Suffix:
Gender:M
Credentials:DMD, DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 E DUPONT RD
Mailing Address - Street 2:C
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1546
Mailing Address - Country:US
Mailing Address - Phone:260-490-2013
Mailing Address - Fax:260-490-1081
Practice Address - Street 1:2121 E DUPONT RD
Practice Address - Street 2:C
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1546
Practice Address - Country:US
Practice Address - Phone:260-490-2013
Practice Address - Fax:260-490-1081
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN83481223G0001X
IL019027483122300000X
PADS0362911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440525Medicaid