Organization
AMERICAN PEDIATRIC DENTAL DORAL, INC
Active
Other names
American Pediatric Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM ANTONIO PENA DMD, MS, MBA (PRESIDENT)
(305) 407-2134
Entity
Organization
Contact information
Practice address
7950 NW 53RD ST, SUITE 200, DORAL, FL 33166-4653
(305) 407-2134
Mailing address
7950 NW 53RD ST, SUITE 200, DORAL, FL 33166-4653
(305) 407-2134
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN17608
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000641100
—
FL
Enumeration date
10/20/2014
Last updated
10/20/2014
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