Provider Demographics
NPI:1033780028
Name:PUHA, MARIUS (DMD)
Entity Type:Individual
Prefix:
First Name:MARIUS
Middle Name:
Last Name:PUHA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8922 W CALLE LEJOS
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1212
Mailing Address - Country:US
Mailing Address - Phone:708-655-4739
Mailing Address - Fax:
Practice Address - Street 1:4850 N 83RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-1052
Practice Address - Country:US
Practice Address - Phone:623-385-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011090122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist