Geoffrey Glen Pena, DMD
Dentist, General Practice in Tracy, CA. Individual provider (NPI-1).
NPI number1962014282
StatusActive
Last updated in NPPESAug 18, 2020
Details
- NPI
- 1962014282
- Entity type
- Individual (NPI-1)
- Name
- Geoffrey Glen Pena
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 18, 2020
- Certification date
- Aug 18, 2020
- Last updated
- Aug 18, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 105245 | CA | Yes |
Practice location
1401 W 11th St Ste ATracy, CA 95376-3702
Phone 209-830-7477
Mailing address
1401 W 11th St Ste ATracy, CA 95376-3702
Phone 209-830-7477
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