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General NPI Number Information
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NPI Number | 1710328141
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Entity Type | Individual
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Provider Name | LAURA M. DE PENA D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2013
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 16919 N BAY RD #509
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160-4253
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Country | US
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Telephone | 561-506-8692
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Fax |
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Provider Business Mailing Address
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Address Line | 16919 N BAY RD APT. 509
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160-4253
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Country | US
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Telephone | 561-506-8692
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN20244
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License Number State | FL
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