Healthcare Provider Details

I. General information

NPI: 1326264847
Provider Name (Legal Business Name): OSVALDO N PUIG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 AVE PONCE DE LEON #5
SAN JUAN PR
00918-3490
US

IV. Provider business mailing address

452 AVE PONCE DE LEON #5
SAN JUAN PR
00918-3490
US

V. Phone/Fax

Practice location:
  • Phone: 787-250-7424
  • Fax:
Mailing address:
  • Phone: 787-250-7424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDM02126
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: