MEDICARE: DR. DAVID A PENFOLD D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	08654	IA

General Provider Information

NPI Number	:	1639308430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A PENFOLD D.D.S.

Provider Business Mailing Address
First Line	:	3223 4TH ST. SW
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401
Country	:	US
Telephone Number	:	641-424-6461
Fax Number	:	641-424-9186

Provider Business Practice Location Address
First Line	:	3223 4TH ST SW
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-1583
Country	:	US
Telephone Number	:	641-424-6461
Fax Number	:	641-424-9186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	07/14/2009

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