Provider Demographics
NPI:1992827455
Name:PENA, RAFAEL F (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:F
Last Name:PENA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:355 W DUNDEE RD
Mailing Address - Street 2:SUITE 219
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3500
Mailing Address - Country:US
Mailing Address - Phone:847-808-9292
Mailing Address - Fax:847-831-4892
Practice Address - Street 1:355 W DUNDEE RD
Practice Address - Street 2:SUITE 219
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3500
Practice Address - Country:US
Practice Address - Phone:847-808-9292
Practice Address - Fax:847-831-4892
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist