MEDICARE: DR. E. GRAY PENTON DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4870	AL

General Provider Information

NPI Number	:	1588745129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. E. GRAY PENTON DMD

Provider Business Mailing Address
First Line	:	4724 WOODMERE BLVD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-3065
Country	:	US
Telephone Number	:	334-277-8767
Fax Number	:

Provider Business Practice Location Address
First Line	:	4724 WOODMERE BLVD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-3065
Country	:	US
Telephone Number	:	334-277-8767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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