Provider Demographics
NPI:1487881447
Name:PUGA, PUREZA (RDH)
Entity type:Individual
Prefix:
First Name:PUREZA
Middle Name:
Last Name:PUGA
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 1:4801 WILSON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1975
Mailing Address - Country:US
Mailing Address - Phone:281-441-1065
Mailing Address - Fax:281-441-1505
Practice Address - Street 1:4801 WILSON RD STE 200
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-1975
Practice Address - Country:US
Practice Address - Phone:281-441-1065
Practice Address - Fax:281-441-1505
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7920124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist