Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN011953 | GA |
NPI | 1093885618 |
---|---|
Provider Name | Dr. Alberto Lugo |
First Address | Columbus, GA 31909-3169 |
Second Address | Columbus, GA 31909-3169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 08/07/2007 |