Provider Demographics
NPI:1962604835
Name:PUPO, YUSIMY (DDS)
Entity type:Individual
Prefix:MS
First Name:YUSIMY
Middle Name:
Last Name:PUPO
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 1:18177 SW 4TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-4350
Mailing Address - Country:US
Mailing Address - Phone:305-888-8260
Mailing Address - Fax:305-888-5531
Practice Address - Street 1:1491 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3527
Practice Address - Country:US
Practice Address - Phone:305-888-8260
Practice Address - Fax:305-888-5531
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN170691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice