| NPI | 1285734640 |
|---|---|
| Professional Name | WANDA PUCKETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 6108) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 0366751) |
| 122300000X Dentist (Licence: CT 08746) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2013-08-21 |