NPIMap

Organization Active NPI

Carla D Pena DDS Inc

  • General Practice Dentistry
  • Tracy, CA
National Provider Identifier
1497199830
Registry record updated Apr 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
47774 Issued in CA
Legal business name
CARLA D PENA DDS INC
Practice address
1401 W 11TH St Ste a
Tracy, CA 95376-3702
Phone
(209) 830-7477
Fax
(209) 830-7977
NPI assigned
Apr 27, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2013

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

Authorized official

Name
Carla D Pena, DDSNPI 1043229297
Title
President
Phone
(209) 830-7477

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 47774 CA Primary

Addresses

Primary practice location

1401 W 11TH St Ste a
Tracy, CA 95376-3702

Mailing address

1401 W 11TH St Ste a
Tracy, CA 95376-3702
Phone (209) 830-7477

National Provider Directory

National Provider Directory

Locations

1401 W 11th St
Ste A
Tracy, CA 95376
Phone (209) 830-7477

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1367020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367020800000",
    "number": "1497199830",
    "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": "953763702",
            "telephone_number": "209-830-7477",
            "fax_number": "209-830-7977"
        },
        {
            "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": "953763702",
            "telephone_number": "209-830-7477",
            "fax_number": "209-830-7977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLA D PENA DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-27",
        "last_updated": "2013-04-27",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-830-7477",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "47774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tracy, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.