Individual
RICARDO LUGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
1501 KINGS HWY RM 530, SHREVEPORT, LA 71103-4228
(318) 675-6036
(318) 675-6129
Mailing address
1501 KINGS HWY RM 530, SHREVEPORT, LA 71103-4228
(318) 675-6036
(318) 675-6129
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
63027
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
S-991
LA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
311638
LA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
A158305
CA
Other
Enumeration date
06/19/2014
Last updated
07/24/2019
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