MEDICARE: DR. SONIA I. PENA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	DN8594	FL

General Provider Information

NPI Number	:	1528077476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONIA I. PENA DMD

Provider Business Mailing Address
First Line	:	1312 E BROWARD BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2136
Country	:	US
Telephone Number	:	954-463-3636
Fax Number	:	954-463-2320

Provider Business Practice Location Address
First Line	:	3020 NE 32ND AVE STE 322
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-7204
Country	:	US
Telephone Number	:	954-990-5363
Fax Number	:	954-990-5377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	12/04/2019

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