Provider Demographics
NPI:1851548770
Name:OSCAR M PENA
Entity Type:Organization
Organization Name:OSCAR M PENA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS, PC
Authorized Official - Phone:520-299-6662
Mailing Address - Street 1:1605 E RIVER RD
Mailing Address - Street 2:SUITE 151
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5971
Mailing Address - Country:US
Mailing Address - Phone:520-299-6662
Mailing Address - Fax:520-299-5558
Practice Address - Street 1:1605 E RIVER RD
Practice Address - Street 2:SUITE 151
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5971
Practice Address - Country:US
Practice Address - Phone:520-299-6662
Practice Address - Fax:520-299-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty