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Contact Information

WANDA PUCKETT, DDS
2000 OPELOUSAS STREET
LAKE CHARLES, LA70601
 Phone: 337-439-9983
 Fax: 337-439-3224
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
 

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for WANDA PUCKETT · (Female)

NPI # 1285734640
Status Active
Credentials DDS (Doctor of Dental Surgery)
Entity Individual
Enumeration date 09/25/2006
Last updated 08/21/2013 - About 13 years ago
Sole proprietor 1 No
Identifiers
  • CT License # 08746
  • LA License # 6108
  • NY License # 0366751
  • NY Medicaid 00749308
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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