Provider Demographics
NPI:1184705105
Name:PUTZLACHER, ISABELA LOREDANA (DDS)
Entity type:Individual
Prefix:DR
First Name:ISABELA
Middle Name:LOREDANA
Last Name:PUTZLACHER
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 1:561 WICKLUND CROSSING
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95391
Mailing Address - Country:US
Mailing Address - Phone:209-839-8755
Mailing Address - Fax:209-839-8754
Practice Address - Street 1:561 WICKLUND CROSSING
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOUSE
Practice Address - State:CA
Practice Address - Zip Code:95391
Practice Address - Country:US
Practice Address - Phone:209-839-8755
Practice Address - Fax:209-839-8754
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice