Healthcare Provider Details

I. General information

NPI: 1417153040
Provider Name (Legal Business Name): MONICA PUENTES DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6222 W MANCHESTER AVE STE. B
WESTCHESTER CA
90045-3801
US

IV. Provider business mailing address

6222 W MANCHESTER AVE
WESTCHESTER CA
90045-3801
US

V. Phone/Fax

Practice location:
  • Phone: 310-670-7800
  • Fax: 310-670-7812
Mailing address:
  • Phone: 310-670-7800
  • Fax: 310-670-7812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number52400
License Number StateCA

VIII. Authorized Official

Name: MONICA PUENTES
Title or Position: DENTIST
Credential:
Phone: 310-670-7800