Individual
DR. CARLOS EDUARDO DE LA PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., P.C
Contact information
Practice address
2230 N VETERANS BLVD, SUITE 200, EAGLE PASS, TX 78852-6619
(830) 773-0707
(830) 757-4550
Mailing address
PO BOX 618, 2230 VETERANS BLVD STE 200, EAGLE PASS, TX 78853-0618
(830) 773-0707
(830) 757-4550
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D18633
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009317101
—
TX
01
—
742787735
TAX ID #
TX
01
—
D18633
DENTAL LICEINCE
TX
Enumeration date
11/01/2006
Last updated
07/09/2007
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