Provider Demographics
NPI:1255340279
Name:NAZARIO LUGO, BEATRIZ T (DMD)
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:T
Last Name:NAZARIO LUGO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5965 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2436
Mailing Address - Country:US
Mailing Address - Phone:305-662-7702
Mailing Address - Fax:305-662-2552
Practice Address - Street 1:5965 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2436
Practice Address - Country:US
Practice Address - Phone:305-662-7702
Practice Address - Fax:305-662-2552
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN178811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry