Basic Information
| Provider Information | |||||||||
| NPI: | 1992137533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PENAFLORIDA | ||||||||
| FirstName: | NEIL | ||||||||
| MiddleName: | GRANT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 29560 RANCHO CALIFORNIA RD | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925915294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516992144 | ||||||||
| FaxNumber: | 9515064040 | ||||||||
| Practice Location | |||||||||
| Address1: | 2878 CAMPUS PKWY | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925070966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9515710011 | ||||||||
| FaxNumber: | 9515710012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2013 | ||||||||
| LastUpdateDate: | 01/06/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 58441 | CA | Y | Dental Providers | Dentist |
No ID Information.