Provider Demographics
NPI:1851438451
Name:CARLOS E. DE LA PENA, D.D.S., P.C.
Entity Type:Organization
Organization Name:CARLOS E. DE LA PENA, D.D.S., P.C.
Other - Org Name:FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT-DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:DE LA PENA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-773-0707
Mailing Address - Street 1:P O BOX 618
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852
Mailing Address - Country:US
Mailing Address - Phone:830-773-0707
Mailing Address - Fax:830-757-4550
Practice Address - Street 1:2230 VETERANS BLVD SUITE 200
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852
Practice Address - Country:US
Practice Address - Phone:830-773-0707
Practice Address - Fax:830-757-4550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty