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General NPI Number Information
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NPI Number | 1780023275
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Entity Type | Individual
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Provider Name | BRITTNEY ANN PENBERTHY D.D.S
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Gender | Female
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 509 W HANLEY AVE STE 202
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City | COEUR D ALENE
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State | ID
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Zip | 83815-8994
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Country | US
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Telephone | 208-667-8622
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Fax | 208-664-2402
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Provider Business Mailing Address
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Address Line | 509 W HANLEY AVE STE 202
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City | COEUR D ALENE
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State | ID
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Zip | 83815-8994
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Country | US
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Telephone | 208-667-8622
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Fax | 208-664-2402
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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 | DEN-DEN-LIC-5941
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30909
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D4493-EN
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License Number State | ID
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