Provider Demographics
NPI:1730364944
Name:PENROD DENTAL CARE, INC.
Entity type:Organization
Organization Name:PENROD DENTAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMOUSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-459-0399
Mailing Address - Street 1:29819 SANTA MARGARITA PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3620
Mailing Address - Country:US
Mailing Address - Phone:949-459-0399
Mailing Address - Fax:949-713-3665
Practice Address - Street 1:29819 SANTA MARGARITA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3620
Practice Address - Country:US
Practice Address - Phone:949-459-0399
Practice Address - Fax:949-713-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508089996OtherNPI