Roque Abel Penaloza, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6992 Issued in SC

Practice address

1140 N Pleasantburg Dr Ste D
Greenville, SC 29607-1256

Phone

(864) 252-8296

Fax

(888) 841-1350

NPI assigned

Sep 18, 2008

Last updated

Jun 27, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Mejia & Penaloza LLC

  dba Greenville Dental Office

  • General Practice Dentistry
  • Greenville, SC
  • NPI 1285992289
  NPD (past)

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

{
    "created_epoch": "1221696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309132800000",
    "number": "1790934305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 N PLEASANTBURG DR STE D",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296071256",
            "telephone_number": "864-252-8296",
            "fax_number": "888-841-1350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 N PLEASANTBURG DR STE D",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296071256",
            "telephone_number": "864-252-8296",
            "fax_number": "888-841-1350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENALOZA",
        "first_name": "ROQUE",
        "middle_name": "ABEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-18",
        "last_updated": "2011-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "052249",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "6992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Ferstadt Pellizzeri, MD
• Sydney Pemberton, MSP, CCC-SLP
• Elizabeth Pena
• Julissa Pena
• Michael Leo Pena Jr.
• David Condon Pence
• Jennifer Pence
• Jennifer Tippett Pence, RN
• Helen Melette Pendarvis
• Pendleton Place Inc

• General Practice Dentistry in Greenville, SC
• Providers in Greenville, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2011; 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.