Provider Demographics
NPI:1457490724
Name:PENA, ROBERT LIMCAOCO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LIMCAOCO
Last Name:PENA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22930 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2718
Mailing Address - Country:US
Mailing Address - Phone:661-222-7171
Mailing Address - Fax:661-222-7535
Practice Address - Street 1:22930 LYONS AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2718
Practice Address - Country:US
Practice Address - Phone:661-222-7171
Practice Address - Fax:661-222-7535
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice