Provider Demographics
NPI:1720472764
Name:ROBERT L. PENA DMD DENTAL CORP.
Entity Type:Organization
Organization Name:ROBERT L. PENA DMD DENTAL CORP.
Other - Org Name:SANTA CLARITA FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LIMCAOCO
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-222-7171
Mailing Address - Street 1:22930 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2718
Mailing Address - Country:US
Mailing Address - Phone:661-222-7171
Mailing Address - Fax:661-222-7535
Practice Address - Street 1:22930 LYONS AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2718
Practice Address - Country:US
Practice Address - Phone:661-222-7171
Practice Address - Fax:661-222-7535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37002305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization