Provider Demographics
NPI:1952386682
Name:PENCE DENTAL CORPORATION
Entity type:Organization
Organization Name:PENCE DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PENCE
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-485-1605
Mailing Address - Street 1:1000 TOWN CENTER DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-1100
Mailing Address - Country:US
Mailing Address - Phone:805-485-1605
Mailing Address - Fax:805-485-9838
Practice Address - Street 1:1000 TOWN CENTER DR
Practice Address - Street 2:SUITE 250
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-1100
Practice Address - Country:US
Practice Address - Phone:805-485-1605
Practice Address - Fax:805-485-9838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18260122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty