Provider Demographics
NPI:1679468433
Name:LAGO, JESUS YONMAY (DMD)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:YONMAY
Last Name:LAGO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SALAMANCA AVE APT 804
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4166
Mailing Address - Country:US
Mailing Address - Phone:305-767-5843
Mailing Address - Fax:
Practice Address - Street 1:1 ALHAMBRA PLZ STE 25
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5216
Practice Address - Country:US
Practice Address - Phone:786-507-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN304411223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice