Provider Demographics
NPI:1083624100
Name:SONIA I PENA DMD PA
Entity Type:Organization
Organization Name:SONIA I PENA DMD PA
Other - Org Name:BROWARD ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:IDALIA
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-463-3636
Mailing Address - Street 1:3020 NE 32 AVE
Mailing Address - Street 2:STE 322
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-990-5363
Mailing Address - Fax:954-990-5377
Practice Address - Street 1:3020 NE 32 AVE
Practice Address - Street 2:STE 322
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-990-5363
Practice Address - Fax:954-990-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL85941223E0200X
FLDN85941223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty