Healthcare Provider Details

I. General information

NPI: 1912897265
Provider Name (Legal Business Name): IGNACIO PUENTE NIETO SR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17008 13TH ST
HURON CA
93234
US

IV. Provider business mailing address

17008 13TH ST
HURON CA
93234
US

V. Phone/Fax

Practice location:
  • Phone: 559-646-6618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: