Provider Demographics
NPI:1649324351
Name:LUGO, GASPAR G (DMD)
Entity type:Individual
Prefix:
First Name:GASPAR
Middle Name:G
Last Name:LUGO
Suffix:
Gender:M
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:EDIFICIO PUIERTA DEL NORTE #22
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-884-2237
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO PUERTA DEL NORTE #22
Practice Address - Street 2:SUITE 9
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21631223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics