Provider Demographics
NPI:1548650898
Name:PATRICIA PENA ARCE,DDS,PC
Entity type:Organization
Organization Name:PATRICIA PENA ARCE,DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRIICIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:PENA ARCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-231-7960
Mailing Address - Street 1:55 SECOND AVE.,SUITE 8
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4665
Mailing Address - Country:US
Mailing Address - Phone:631-231-7960
Mailing Address - Fax:631-231-7987
Practice Address - Street 1:55 SECOND AVE.,SUITE 8
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4665
Practice Address - Country:US
Practice Address - Phone:631-231-7960
Practice Address - Fax:631-231-7987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0497871223G0001X
NY0523531223G0001X
NY0514491223G0001X
NY0428521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty