Healthcare Provider Details

I. General information

NPI: 1982711065
Provider Name (Legal Business Name): PETER R PUGLIESE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

2391 W SILVER PALM RD
BOCA RATON FL
33432-7960
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-7515
  • Fax: 954-262-1782
Mailing address:
  • Phone: 561-504-6684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12542
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDTP610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: