Provider Demographics
NPI:1083623326
Name:PENNARTZ, TODD MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MARTIN
Last Name:PENNARTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 W WALKER ST
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:76424
Mailing Address - Country:US
Mailing Address - Phone:254-559-2122
Mailing Address - Fax:254-559-2153
Practice Address - Street 1:1905 W WALKER ST
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:TX
Practice Address - Zip Code:76424
Practice Address - Country:US
Practice Address - Phone:254-559-2122
Practice Address - Fax:254-559-2153
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice