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General NPI Number Information
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NPI Number | 1073695516
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Entity Type | Individual
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Provider Name | DIANE MANNING PENNINGTON D.M.D., M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 1891 GA HIGHWAY 40 E SUITE 1104
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City | KINGSLAND
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State | GA
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Zip | 31548-6572
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Country | US
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Telephone | 912-673-6545
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Fax | 912-576-1846
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Provider Business Mailing Address
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Address Line | 73 HAWTHORN LN
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City | SAINT MARYS
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State | GA
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Zip | 31558-4026
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Country | US
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Telephone | 912-673-6545
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Fax | 612-576-1846
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN011196
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License Number State | GA
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