1326475203 NPI number — MARTA A. PENMAN, DDS, A PROFESSIONAL DENTAL CORPORATION

Table of content: (NPI 1326475203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326475203 NPI number — MARTA A. PENMAN, DDS, A PROFESSIONAL DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTA A. PENMAN, DDS, A PROFESSIONAL DENTAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326475203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1207 CARLSBAD VILLAGE DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92008-1957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-434-7374
Provider Business Mailing Address Fax Number:
760-434-1605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1207 CARLSBAD VILLAGE DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92008-1957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-434-7374
Provider Business Practice Location Address Fax Number:
760-434-1605
Provider Enumeration Date:
10/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PENMAN
Authorized Official First Name:
MARTA
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
760-845-8858

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  44056 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 46363 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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