Provider Demographics
NPI:1447791819
Name:DIAZ PUENTES, CAROLINA (DDS MPH)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:DIAZ PUENTES
Suffix:
Gender:F
Credentials:DDS MPH
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:DIAZ GUILLORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS MPH
Mailing Address - Street 1:834 SW MILITARY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:834 SW MILITARY DRIVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221
Practice Address - Country:US
Practice Address - Phone:602-842-2765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32238122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist