Provider Demographics
NPI:1275654741
Name:PENALOSA, PINKY (DDS)
Entity Type:Individual
Prefix:
First Name:PINKY
Middle Name:
Last Name:PENALOSA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 FOOTHILL BLVD
Mailing Address - Street 2:SUITE #106
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7694
Mailing Address - Country:US
Mailing Address - Phone:909-941-2288
Mailing Address - Fax:909-941-6688
Practice Address - Street 1:10801 FOOTHILL BLVD
Practice Address - Street 2:SUITE #106
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7694
Practice Address - Country:US
Practice Address - Phone:909-941-2288
Practice Address - Fax:909-941-6688
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice