Provider Demographics
NPI:1326580903
Name:ELENA C PUIG, DMD, PA
Entity Type:Organization
Organization Name:ELENA C PUIG, DMD, PA
Other - Org Name:DYNAMIC SMILE DESIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PUIG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-895-5600
Mailing Address - Street 1:1600 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4810
Mailing Address - Country:US
Mailing Address - Phone:407-895-5600
Mailing Address - Fax:
Practice Address - Street 1:1600 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4810
Practice Address - Country:US
Practice Address - Phone:407-895-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1174676050OtherNPI