Provider Demographics
NPI:1588951859
Name:PUIG QUINONES, LYANN MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:LYANN
Middle Name:MARIE
Last Name:PUIG QUINONES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 CALLE DR PAVIA FERNANDEZ STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2243
Mailing Address - Country:US
Mailing Address - Phone:787-268-3200
Mailing Address - Fax:
Practice Address - Street 1:611 CALLE DR PAVIA FERNANDEZ STE 208
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2243
Practice Address - Country:US
Practice Address - Phone:787-268-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056371122300000X
PR32151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist