Provider Demographics
NPI:1093197337
Name:PENNINGTON, BRANDON (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 WINSTON WAY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-3954
Mailing Address - Country:US
Mailing Address - Phone:205-253-1503
Mailing Address - Fax:
Practice Address - Street 1:4165 WINSTON WAY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-3954
Practice Address - Country:US
Practice Address - Phone:205-253-1503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program