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NPI Code Detail

MEDICARE: DR. MATTHEW T PENZ D.D.S.

MEDICARE: DR. MATTHEW T PENZ 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
11223G0001XGeneral Practice DentistryD13096MN

General Provider Information

NPI Number : 1952669517
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW T PENZ D.D.S.
Provider Business Mailing Address
First Line : 1615 14TH ST NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-0257
Country : US
Telephone Number : 507-289-3921
Fax Number : 507-288-2450
Provider Business Practice Location Address
First Line : 1615 14TH ST NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-0257
Country : US
Telephone Number : 507-289-3921
Fax Number : 507-288-2450
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2012
Last Update Date : 10/13/2016

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