Provider Demographics
NPI:1790016202
Name:PUIG, LIANA (DDS)
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:
Last Name:PUIG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5870 SW 8TH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5052
Mailing Address - Country:US
Mailing Address - Phone:305-266-0011
Mailing Address - Fax:305-260-0770
Practice Address - Street 1:5870 SW 8TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5052
Practice Address - Country:US
Practice Address - Phone:305-266-0011
Practice Address - Fax:305-260-0770
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN158541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice