Provider Demographics
NPI:1285110379
Name:MATTHEW D JUGOVICH DDS PA
Entity type:Organization
Organization Name:MATTHEW D JUGOVICH DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKITALO
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:218-729-7270
Mailing Address - Street 1:5651 MILLER TRUNK HWY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1229
Mailing Address - Country:US
Mailing Address - Phone:218-729-7270
Mailing Address - Fax:218-729-0339
Practice Address - Street 1:5651 MILLER TRUNK HWY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-1229
Practice Address - Country:US
Practice Address - Phone:218-729-7270
Practice Address - Fax:218-729-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental