Provider Demographics
NPI:1174777825
Name:PUENTE, ALYSSIA KRISTINE (RDH)
Entity type:Individual
Prefix:MRS
First Name:ALYSSIA
Middle Name:KRISTINE
Last Name:PUENTE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 LEASURE ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-4220
Mailing Address - Country:US
Mailing Address - Phone:503-580-6650
Mailing Address - Fax:
Practice Address - Street 1:620 LEASURE ST
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-4220
Practice Address - Country:US
Practice Address - Phone:503-580-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5426124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist