Provider Demographics
NPI:1598459729
Name:PUENTES MARRERO, MARTA MILAGROS (DMD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:MILAGROS
Last Name:PUENTES MARRERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14270 SW 68TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2150
Mailing Address - Country:US
Mailing Address - Phone:786-623-9879
Mailing Address - Fax:
Practice Address - Street 1:12251 TAFT ST STE 200
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-1956
Practice Address - Country:US
Practice Address - Phone:954-441-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN278631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice