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General NPI Number Information
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NPI Number | 1104970383
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Entity Type | Individual
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Provider Name | MICHAEL JERRY LUGTU DDS
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15122 PARAMOUNT BLVD
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City | PARAMOUNT
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State | CA
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Zip | 90723-4337
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Country | US
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Telephone | 562-630-2222
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Fax | 562-630-4690
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Provider Business Mailing Address
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Address Line | 16369 BROOKSTONE CIR
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City | LA MIRADA
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State | CA
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Zip | 90638-6531
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Country | US
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Telephone | 562-943-6898
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Fax | 562-630-4690
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 42851
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License Number State | CA
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