Geoffrey Glen Pena, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

105245 Issued in CA

Practice address

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

Phone

(209) 830-7477

NPI assigned

Aug 18, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Specialty

Dentist

Education

Univ of Nevada, Las Vegas School of Dental Med, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Carla D Pena DDS Inc

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

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

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597708800000",
    "number": "1962014282",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "GEOFFREY",
        "middle_name": "GLEN",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-18",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "105245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sobrique Peavey
• Berenis Pelayo Reynoso
• Andrea Lauren Pelayo
• Melanie Pena Robles
• Carla Dolar Pena, D.D.S.
• Veronica Pena
• Haley Pennington
• Alexa Peraza
• Dayanna Yameli Perez Benitez
• Jesus Perez Leon, RBT-24-365545

• 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 Aug 18, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.