Provider Demographics
NPI:1922246388
Name:PENA, WILLIAM ANTONIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ANTONIO
Last Name:PENA
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:10021 PINES BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6191
Mailing Address - Country:US
Mailing Address - Phone:954-417-1337
Mailing Address - Fax:954-417-1338
Practice Address - Street 1:10021 PINES BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6191
Practice Address - Country:US
Practice Address - Phone:954-417-1337
Practice Address - Fax:954-417-1338
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2012-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLDN 176081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000641100Medicaid