MEDICARE: ALTOONA DENTISTRY IMPLANTS DENTURES, INC.

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1891672010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTOONA DENTISTRY IMPLANTS DENTURES, INC.

Provider Business Mailing Address
First Line	:	178 FALON LN
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16602-6541
Country	:	US
Telephone Number	:	814-300-0333
Fax Number	:	814-283-5580

Provider Business Practice Location Address
First Line	:	178 FALON LN
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16602-6541
Country	:	US
Telephone Number	:	814-300-0333
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DAVID T PENNINGTON
Credential	:
Telephone Number	:	814-300-0333

Provider Enumeration Date	:	08/19/2025
Last Update Date	:	10/29/2025

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