Provider Demographics
NPI:1326475203
Name:MARTA A. PENMAN, DDS, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:MARTA A. PENMAN, DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:CARLSBAD PEDIATRIC DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-845-8858
Mailing Address - Street 1:1207 CARLSBAD VILLAGE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1957
Mailing Address - Country:US
Mailing Address - Phone:760-434-7374
Mailing Address - Fax:760-434-1605
Practice Address - Street 1:1207 CARLSBAD VILLAGE DR
Practice Address - Street 2:SUITE A
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1957
Practice Address - Country:US
Practice Address - Phone:760-434-7374
Practice Address - Fax:760-434-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46363122300000X
CA440561223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty