Individual
LUIS MANUEL DE LA PUENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1940 TAMIAMI TRL STE 102, PORT CHARLOTTE, FL 33948-2105
(941) 625-7413
Mailing address
5333 MIKADO CT, CAPE CORAL, FL 33904-5972
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN22534
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN22534
FLORIDA DEPARTMENT OF HEALTH
FL
Enumeration date
05/18/2017
Last updated
05/18/2017
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