MEDICARE: DR. NILDA DOLAGARAY-LUGO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	1344	PR

General Provider Information

NPI Number	:	1558481705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NILDA DOLAGARAY-LUGO DMD

Provider Business Mailing Address
First Line	:	CALLE 4 D-13
Second Line	:	PARQUE MONTEBELLO
City	:	TRUJILLO ALTO
State	:	PR
Zip	:	00976
Country	:	US
Telephone Number	:	787-761-0406
Fax Number	:	787-761-0406

Provider Business Practice Location Address
First Line	:	IA5 AVE LOMAS VERDES
Second Line	:	ROYAL PALM
City	:	BAYAMON
State	:	PR
Zip	:	00956-3133
Country	:	US
Telephone Number	:	787-798-7340
Fax Number	:	787-798-6080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	05/11/2011

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