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General NPI Number Information
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NPI Number | 1033210380
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Entity Type | Organization
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Legal Business Name | NICHOLAS JAMES PENNA D.D.S.,P.A.
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1819 BRENNER AVE
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City | SALISBURY
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State | NC
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Zip | 28144-2519
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Country | US
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Telephone | 704-633-5942
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Fax | 704-639-0237
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Provider Business Mailing Address
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Address Line | 1819 BRENNER AVE
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City | SALISBURY
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State | NC
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Zip | 28144-2519
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Country | US
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Telephone | 704-633-5942
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Fax | 704-639-0237
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICHOLAS JAMES PENNA
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Credential | D.D.S.
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Telephone | 704-633-5942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | NC4936
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License Number State | NC
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