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General NPI Number Information
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NPI Number | 1417394396
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Entity Type | Individual
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Provider Name | MARK A PENSHORN DDS
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Gender | Male
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Dates
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Enumeration Date | 05/31/2013
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Last Update Date | 05/31/2013
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Provider Practice Location Address
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Address Line | 2501 FM 3009
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City | SCHERTZ
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State | TX
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Zip | 78154-2714
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Country | US
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Telephone | 210-659-1379
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Fax | 210-659-6215
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Provider Business Mailing Address
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Address Line | 2501 FM 3009
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City | SCHERTZ
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State | TX
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Zip | 78154-2714
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Country | US
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Telephone | 210-659-1379
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Fax | 210-659-6215
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 13376
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License Number State | TX
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