Provider Demographics
NPI:1356498562
Name:PENCE, DAMON RAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:RAY
Last Name:PENCE
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 1:3590 TROY PIKE
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-9647
Mailing Address - Country:US
Mailing Address - Phone:859-873-7438
Mailing Address - Fax:
Practice Address - Street 1:3590 TROY PIKE
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-9647
Practice Address - Country:US
Practice Address - Phone:859-873-7438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY5609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist