Provider Demographics
NPI:1528077476
Name:PENA, SONIA I (DMD)
Entity type:Individual
Prefix:DR
First Name:SONIA
Middle Name:I
Last Name:PENA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 E BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2136
Mailing Address - Country:US
Mailing Address - Phone:954-463-3636
Mailing Address - Fax:954-463-2320
Practice Address - Street 1:3020 NE 32ND AVE STE 322
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7204
Practice Address - Country:US
Practice Address - Phone:954-990-5363
Practice Address - Fax:954-990-5377
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN85941223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics