Provider Demographics
NPI:1366772477
Name:PUNZALAN, ENGRACIA SAMIA (DDS)
Entity type:Individual
Prefix:DR
First Name:ENGRACIA
Middle Name:SAMIA
Last Name:PUNZALAN
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 1:2560 E AMAR RD STE B2
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-2234
Mailing Address - Country:US
Mailing Address - Phone:626-912-8455
Mailing Address - Fax:
Practice Address - Street 1:2560 E AMAR RD STE B2
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-2234
Practice Address - Country:US
Practice Address - Phone:626-912-8455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA035021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist