Provider Demographics
NPI:1689950420
Name:PENA DE CARRENO, INGRID (DMD)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:
Last Name:PENA DE CARRENO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:CELESTE DE JESUS
Other - Last Name:PENA GUZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 WHITNEY CT
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-7120
Mailing Address - Country:US
Mailing Address - Phone:978-686-3577
Mailing Address - Fax:
Practice Address - Street 1:100 AMESBURY ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1321
Practice Address - Country:US
Practice Address - Phone:978-686-8500
Practice Address - Fax:978-686-1592
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18558291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice