Provider Demographics
NPI:1801876024
Name:LUGO, LUIS ANTONIO (DMD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ANTONIO
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 1:4201 NESHAMINY BLVD STE 117
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1620
Mailing Address - Country:US
Mailing Address - Phone:215-396-9080
Mailing Address - Fax:215-396-9081
Practice Address - Street 1:4201 NESHAMINY BLVD STE 117
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1620
Practice Address - Country:US
Practice Address - Phone:215-396-9080
Practice Address - Fax:215-396-9081
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0361321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
BL9048542OtherFEDERAL DEA