Provider Demographics
NPI:1295225753
Name:PINKY D. PENALOSA, DMD INC.
Entity Type:Organization
Organization Name:PINKY D. PENALOSA, DMD INC.
Other - Org Name:OASIS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PINKY
Authorized Official - Middle Name:DEL FIERRO
Authorized Official - Last Name:PENALOSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-941-2288
Mailing Address - Street 1:9203 ARCHIBALD AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5207
Mailing Address - Country:US
Mailing Address - Phone:909-941-2288
Mailing Address - Fax:909-941-6688
Practice Address - Street 1:9203 ARCHIBALD AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5207
Practice Address - Country:US
Practice Address - Phone:909-941-2288
Practice Address - Fax:909-941-6688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS527691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275654741OtherNPPES