=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326580903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELENA C PUIG, DMD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2016
-----------------------------------------------------
Last Update Date | 11/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 HILLCREST ST
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32803-4810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-895-5600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 HILLCREST ST
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32803-4810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-895-5600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | DR. ELENA C PUIG
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 407-895-5600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN21934
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------