=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548650898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRICIA PENA ARCE,DDS,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2015
-----------------------------------------------------
Last Update Date | 02/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 SECOND AVE.,SUITE 8
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11717-4665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-231-7960
-----------------------------------------------------
Fax | 631-231-7987
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 SECOND AVE.,SUITE 8
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11717-4665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-231-7960
-----------------------------------------------------
Fax | 631-231-7987
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL DENTIST
-----------------------------------------------------
Name | DR. PATRIICIA I PENA ARCE
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 631-231-7960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 049787
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 052353
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 051449
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 042852
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------