Provider Demographics
NPI:1740433242
Name:PENA, BLANCA ERIKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLANCA
Middle Name:ERIKA
Last Name:PENA
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 1:8515 GREENVILLE AVE STE N108
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7035
Mailing Address - Country:US
Mailing Address - Phone:214-221-0855
Mailing Address - Fax:214-221-1437
Practice Address - Street 1:8515 GREENVILLE AVE STE N108
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7035
Practice Address - Country:US
Practice Address - Phone:214-221-0855
Practice Address - Fax:214-221-1437
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23978122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist