Healthcare Provider Details

I. General information

NPI: 1477491926
Provider Name (Legal Business Name): MONIQUE LUGO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 E 420 S
LEHI UT
84043-2002
US

IV. Provider business mailing address

632 E 420 S
LEHI UT
84043-2002
US

V. Phone/Fax

Practice location:
  • Phone: 860-214-4389
  • Fax:
Mailing address:
  • Phone: 860-214-4389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7133442-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: