Healthcare Provider Details

I. General information

NPI: 1558491878
Provider Name (Legal Business Name): PHILIP J. PUNEKY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71359 HIGHWAY 59
ABITA SPRINGS LA
70420-3707
US

IV. Provider business mailing address

71359 HIGHWAY 59
ABITA SPRINGS LA
70420-3707
US

V. Phone/Fax

Practice location:
  • Phone: 504-392-8484
  • Fax: 985-809-7562
Mailing address:
  • Phone: 504-392-8484
  • Fax: 985-809-7562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3581
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: