Provider Demographics
NPI:1811745540
Name:PENA, NATALIA (DMD)
Entity type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 S PLYMOUTH CT APT 707
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2045
Mailing Address - Country:US
Mailing Address - Phone:847-744-0153
Mailing Address - Fax:
Practice Address - Street 1:8908 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-2006
Practice Address - Country:US
Practice Address - Phone:708-498-4698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program