1104248640 NPI number — DENTON FAMILY PRACTICE ASSOCIATES, PLLC

Table of content: YANAY PUENTE DUNCAN BS (NPI 1700398617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104248640 NPI number — DENTON FAMILY PRACTICE ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTON FAMILY PRACTICE ASSOCIATES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104248640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1605 N LOCUST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76201-3042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-565-0002
Provider Business Mailing Address Fax Number:
940-565-9733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1605 N LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76201-3042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-565-0002
Provider Business Practice Location Address Fax Number:
940-565-9733
Provider Enumeration Date:
01/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
STEPHEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
940-665-0721

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  M1806 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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