Healthcare Provider Details

I. General information

NPI: 1720722143
Provider Name (Legal Business Name): JOSHUA PENNERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 OVERHILL RD STE 110
SCARSDALE NY
10583-5316
US

IV. Provider business mailing address

159 FIELDPOINT DR
IRVINGTON NY
10533-1860
US

V. Phone/Fax

Practice location:
  • Phone: 914-723-3511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number063766
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: