MEDICARE: DR. PEDRO J RUIZ 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	1223G0001X	General Practice Dentistry	0947	PR

General Provider Information

NPI Number	:	1912993395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEDRO J RUIZ LUGO D.M.D.

Provider Business Mailing Address
First Line	:	38 CALLE AMISTAD
Second Line	:
City	:	LAJAS
State	:	PR
Zip	:	00667-2060
Country	:	US
Telephone Number	:	787-899-2298
Fax Number	:	787-899-2298

Provider Business Practice Location Address
First Line	:	AMISTAD #38
Second Line	:
City	:	LAJAS
State	:	PUERTO RICO
Zip	:	00667
Country	:	UM
Telephone Number	:	787-899-2298
Fax Number	:

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	11/07/2016

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