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General NPI Number Information
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NPI Number | 1326475203
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Entity Type | Organization
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Legal Business Name | MARTA A. PENMAN, DDS, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 10/08/2013
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Last Update Date | 10/08/2013
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Provider Practice Location Address
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Address Line | 1207 CARLSBAD VILLAGE DR SUITE A
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City | CARLSBAD
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State | CA
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Zip | 92008-1957
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Country | US
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Telephone | 760-434-7374
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Fax | 760-434-1605
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Provider Business Mailing Address
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Address Line | 1207 CARLSBAD VILLAGE DR SUITE A
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City | CARLSBAD
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State | CA
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Zip | 92008-1957
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Country | US
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Telephone | 760-434-7374
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Fax | 760-434-1605
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MARTA ANNE PENMAN
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Credential | DDS
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Telephone | 760-845-8858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 44056
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 46363
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License Number State | CA
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