Provider Demographics
NPI:1093159535
Name:DE LAPUENTE, NOSLEN (DDS)
Entity Type:Individual
Prefix:MR
First Name:NOSLEN
Middle Name:
Last Name:DE LAPUENTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SW 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-6126
Mailing Address - Country:US
Mailing Address - Phone:786-380-6225
Mailing Address - Fax:
Practice Address - Street 1:8300 W FLAGLER ST STE 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2096
Practice Address - Country:US
Practice Address - Phone:305-460-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist