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General NPI Number Information
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NPI Number | 1922687326
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Entity Type | Individual
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Provider Name | HAMILTON EVAN PENNYWELL
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Gender | Male
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 4417 W GORE BLVD STE 11
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City | LAWTON
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State | OK
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Zip | 73505-5978
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Country | US
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Telephone | 580-248-8418
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Fax |
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Provider Business Mailing Address
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Address Line | 2171 N HIGHWAY 77
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City | WAXAHACHIE
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State | TX
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Zip | 75165-6215
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Country | US
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Telephone |
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Fax |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8144
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 39755
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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