Provider Demographics
NPI:1740201169
Name:PENA ARCE, PATRICIA I (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:I
Last Name:PENA ARCE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 2ND AVE UNIT 8
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4665
Mailing Address - Country:US
Mailing Address - Phone:631-231-7960
Mailing Address - Fax:631-231-7987
Practice Address - Street 1:55 2ND AVE UNIT 8
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4665
Practice Address - Country:US
Practice Address - Phone:631-231-7960
Practice Address - Fax:631-231-7987
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0428521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice