Provider Demographics
NPI:1639341712
Name:DELBA J. PENA D.D.S., P.C.
Entity Type:Organization
Organization Name:DELBA J. PENA D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DELBA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-483-8136
Mailing Address - Street 1:P.O. BOX 160
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553
Mailing Address - Country:US
Mailing Address - Phone:516-483-8136
Mailing Address - Fax:516-483-8134
Practice Address - Street 1:186 CLINTON ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-2600
Practice Address - Country:US
Practice Address - Phone:516-483-8136
Practice Address - Fax:516-483-8134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047706-1261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01900307Medicaid