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General NPI Number Information
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NPI Number | 1720374838
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Entity Type | Organization
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Legal Business Name | WILLIAM A. PENA DMD, PA
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 10021 PINES BLVD SUITE 100
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6191
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Country | US
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Telephone | 954-417-1337
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Fax | 954-417-1338
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Provider Business Mailing Address
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Address Line | 10021 PINES BLVD SUITE 100
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6191
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Country | US
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Telephone | 954-417-1337
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Fax | 954-417-1338
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. WILLIAM ANTONIO PENA
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Credential | DMD, MS, MBA
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Telephone | 415-216-6649
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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 | DN17608
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License Number State | FL
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