Provider Demographics
NPI:1205849171
Name:PENZIEN, JONATHAN ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ARTHUR
Last Name:PENZIEN
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 1:55131 SHELBY RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TNP
Mailing Address - State:MI
Mailing Address - Zip Code:48317
Mailing Address - Country:US
Mailing Address - Phone:243-650-5500
Mailing Address - Fax:248-650-5675
Practice Address - Street 1:55131 SHELBY RD
Practice Address - Street 2:
Practice Address - City:SHELBY TNP
Practice Address - State:MI
Practice Address - Zip Code:48317
Practice Address - Country:US
Practice Address - Phone:243-650-5500
Practice Address - Fax:248-650-5675
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist