Individual
DIVA ISABEL PUERTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3545 79TH ST, JACKSON HEIGHTS, NY 11372-4818
(718) 335-1331
(718) 396-2593
Mailing address
3555 73RD ST APT 426, JACKSON HEIGHTS, NY 11372-4142
(718) 476-9551
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
052894
NY
Other
Enumeration date
12/18/2006
Last updated
07/08/2007
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