Provider Demographics
NPI:1689848962
Name:PERIODONTAL & ORAL HEALTH, P.S.C.
Entity type:Organization
Organization Name:PERIODONTAL & ORAL HEALTH, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST-PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GASPAR
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-884-2237
Mailing Address - Street 1:EDIFICIO PUERTA DEL NORTE #22
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-884-2237
Mailing Address - Fax:
Practice Address - Street 1:CALLE BALDORIOTI 22
Practice Address - Street 2:SUITE 9
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-2237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2163261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1649324351OtherINDIVIDUAL NPI