Carla Dolar Pena, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

47774 Issued in CA

Practice address

1401 W 11TH St Ste a
Tracy, CA 95376-3733

Phone

(209) 830-7477

NPI assigned

Aug 5, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carla D Pena DDS Inc

  • General Practice Dentistry
  • Tracy, CA
  • NPI 1497199830
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319760000000",
    "number": "1043229297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 W 11TH ST STE A",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953763733",
            "telephone_number": "209-830-7477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 W 11TH ST STE A",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953763733",
            "telephone_number": "209-830-7477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "CARLA",
        "middle_name": "DOLAR",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2011-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "47774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Su-Chio Peak, PSY.D.
• Sobrique Peavey
• Berenis Pelayo Reynoso
• Andrea Lauren Pelayo
• Melanie Pena Robles
• Geoffrey Glen Pena, DMD
• Veronica Pena
• Haley Pennington
• Alexa Peraza
• Dayanna Yameli Perez Benitez

• General Practice Dentistry in Tracy, CA
• Providers in Tracy, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.