Provider Demographics
NPI:1902815632
Name:PENA, PABLO RAMON (DDS)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:RAMON
Last Name:PENA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 HOOKS AVE
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-3342
Mailing Address - Country:US
Mailing Address - Phone:956-464-4514
Mailing Address - Fax:956-461-3410
Practice Address - Street 1:1204 HOOKS AVE
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-3342
Practice Address - Country:US
Practice Address - Phone:956-464-4514
Practice Address - Fax:956-461-3410
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD126851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB12685-01OtherTEXAS CHIP DENTAL ID
TXD12685OtherBCBS PROVIDER NUMBER