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Individual
WANDA PUCKETT
Active
Individual
WANDA PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0366751
NY
122300000X
Dentist
08746
CT
1223G0001X
General Practice Dentistry
Primary
6108
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00749308
—
NY
Enumeration date
09/25/2006
Last updated
08/21/2013
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