Organization Name: | LUGO DMD MARYSVILLE PS |
NPI Number: | 1154675064 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TRACY ELIZABETH SUNDBY (BUSINESS MANAGER) |
Mailing Address: | 9421 N. Davies Road #a Lake Stevens |
State: | WA US |
Postal Code: | 98258 |
Phone Number: | 4253674149 |
Fax Number: | 4256094530 |
NPI Enumeration Date: | 10/30/2012 |
NPI Last Update Date: | 01/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |