Healthcare Provider Details

I. General information

NPI: 1326475203
Provider Name (Legal Business Name): MARTA A. PENMAN, DDS, A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 CARLSBAD VILLAGE DR SUITE A
CARLSBAD CA
92008-1957
US

IV. Provider business mailing address

1207 CARLSBAD VILLAGE DR SUITE A
CARLSBAD CA
92008-1957
US

V. Phone/Fax

Practice location:
  • Phone: 760-434-7374
  • Fax: 760-434-1605
Mailing address:
  • Phone: 760-434-7374
  • Fax: 760-434-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number46363
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number44056
License Number StateCA

VIII. Authorized Official

Name: DR. MARTA ANNE PENMAN
Title or Position: DENTIST
Credential: DDS
Phone: 760-845-8858