Healthcare Provider Details

I. General information

NPI: 1861400855
Provider Name (Legal Business Name): ROBERT A PENNA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 CENTERVILLE RD STE 215
WILMINGTON DE
19808-1664
US

IV. Provider business mailing address

2710 CENTERVILLE RD STE 215
WILMINGTON DE
19808-1664
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-8783
  • Fax: 302-998-8786
Mailing address:
  • Phone: 302-998-8783
  • Fax: 302-998-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS029074L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberG10001080
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberGI0001080
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: