Provider Demographics
NPI:1740323310
Name:MICHAEL J LUGTU DDS INC.
Entity type:Organization
Organization Name:MICHAEL J LUGTU DDS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUGTU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-279-7717
Mailing Address - Street 1:9251 GARVEY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-4609
Mailing Address - Country:US
Mailing Address - Phone:626-279-7717
Mailing Address - Fax:626-279-7977
Practice Address - Street 1:9251 GARVEY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-4609
Practice Address - Country:US
Practice Address - Phone:626-279-7717
Practice Address - Fax:626-279-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG-92283-02OtherDENTAL OFFICE