Provider Demographics
NPI:1730427568
Name:PUNLA SMITH, MARIA VERONICA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:VERONICA
Last Name:PUNLA SMITH
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 1:2215 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-7060
Mailing Address - Country:US
Mailing Address - Phone:920-231-8120
Mailing Address - Fax:
Practice Address - Street 1:2215 OREGON ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-7060
Practice Address - Country:US
Practice Address - Phone:920-231-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI606615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist