Provider Demographics
NPI:1447390711
Name:MICHAEL J LUGTU DDSINC.
Entity type:Organization
Organization Name:MICHAEL J LUGTU DDSINC.
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:562-630-2222
Mailing Address - Street 1:15122 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-4337
Mailing Address - Country:US
Mailing Address - Phone:562-630-2222
Mailing Address - Fax:562-630-4690
Practice Address - Street 1:15122 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-4337
Practice Address - Country:US
Practice Address - Phone:562-630-2222
Practice Address - Fax:562-630-4690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
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-92283-01OtherDENTAL OFFICE