MEDICARE: DR. ROBERT J. LUGO D.M.D

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	18244	TX

General Provider Information

NPI Number	:	1578675914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J. LUGO D.M.D

Provider Business Mailing Address
First Line	:	529 STONE CREEK DR
Second Line	:
City	:	PROSPER
State	:	TX
Zip	:	75078-2547
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N ALLEN DR
Second Line	:	SUITE 305
City	:	ALLEN
State	:	TX
Zip	:	75013-2555
Country	:	US
Telephone Number	:	972-727-5781
Fax Number	:	972-727-5825

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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