Provider Demographics
NPI:1992828495
Name:PENA TEJADA, GILDA (MD)
Entity Type:Individual
Prefix:DR
First Name:GILDA
Middle Name:
Last Name:PENA TEJADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-4221
Mailing Address - Country:US
Mailing Address - Phone:201-865-8900
Mailing Address - Fax:201-865-1002
Practice Address - Street 1:1315 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4221
Practice Address - Country:US
Practice Address - Phone:201-865-8900
Practice Address - Fax:201-865-1002
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0196811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice