Healthcare Provider Details

I. General information

NPI: 1134127566
Provider Name (Legal Business Name): THOMAS J PUHEK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3431 E SUNSET RD SUITE #301
LAS VEGAS NV
89120-3252
US

IV. Provider business mailing address

3431 E SUNSET RD SUITE #301
LAS VEGAS NV
89120-3252
US

V. Phone/Fax

Practice location:
  • Phone: 702-435-3901
  • Fax: 702-435-1378
Mailing address:
  • Phone: 702-435-3901
  • Fax: 702-435-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2889
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: