Provider Demographics
NPI:1235396904
Name:PENN, STEVEN EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:EUGENE
Last Name:PENN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1791 OAK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1073
Mailing Address - Country:US
Mailing Address - Phone:530-753-4530
Mailing Address - Fax:530-753-3263
Practice Address - Street 1:1791 OAK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1073
Practice Address - Country:US
Practice Address - Phone:530-753-4530
Practice Address - Fax:530-753-3263
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294181223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics