William Antonio Pena, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN 17608 Issued in FL

Practice address

10021 Pines Blvd
Suite 100
Pembroke Pines, FL 33024-6191

Phone

(954) 417-1337

Fax

(954) 417-1338

NPI assigned

Jan 23, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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 and National Provider Directory roles.

• American Pediatric Dental Doral, Inc

  • Pediatric Dentistry
  • Doral, FL
  • NPI 1063816122
  NPD (past) Authorized official

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

{
    "created_epoch": "1232668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332288000000",
    "number": "1922246388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10021 PINES BLVD",
            "address_2": "SUITE 100",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330246191",
            "telephone_number": "954-417-1337",
            "fax_number": "954-417-1338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10021 PINES BLVD",
            "address_2": "SUITE 100",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330246191",
            "telephone_number": "954-417-1337",
            "fax_number": "954-417-1338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "WILLIAM",
        "middle_name": "ANTONIO",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-01-23",
        "last_updated": "2012-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN 17608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000641100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fernando Alejandro Pena, FNP
• Indhira Y Pena, RN
• Laura Pena
• Shannon Michelle Pena
• Veronica Andrea Pena
• Ronoel Penalver, M.D
• Elizabeth Carmen Penela, PH.D.
• Youmeizi Peng
• Isabella Penso Mota, RD, LDN
• Penstar Provider Network LLC

• Pediatric Dentistry in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2012; 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.