Provider Demographics
NPI:1659381838
Name:PENA, DELBA JOSEFINA (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:DELBA
Middle Name:JOSEFINA
Last Name:PENA
Suffix:
Gender:F
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 FRONT ST
Mailing Address - Street 2:P.O. BOX 160
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-1638
Mailing Address - Country:US
Mailing Address - Phone:516-483-8134
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY047706122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01900307Medicaid