Provider Demographics
NPI:1689787145
Name:PUNIM, PATRICE S (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICE
Middle Name:S
Last Name:PUNIM
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 1:7891 TALBERT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648
Mailing Address - Country:US
Mailing Address - Phone:714-842-4148
Mailing Address - Fax:714-847-5644
Practice Address - Street 1:7891 TALBERT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648
Practice Address - Country:US
Practice Address - Phone:714-842-4148
Practice Address - Fax:714-847-5644
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA287951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics