Provider Demographics
NPI:1992137533
Name:PENAFLORIDA, NEIL GRANT (DDS)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:GRANT
Last Name:PENAFLORIDA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29560 RANCHO CALIFORNIA RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5294
Mailing Address - Country:US
Mailing Address - Phone:951-699-2144
Mailing Address - Fax:951-506-4040
Practice Address - Street 1:2878 CAMPUS PKWY
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0966
Practice Address - Country:US
Practice Address - Phone:951-571-0011
Practice Address - Fax:951-571-0012
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist