Provider Demographics
NPI:1417054784
Name:BRENT PENNINGTON DMD,LLC
Entity Type:Organization
Organization Name:BRENT PENNINGTON DMD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-935-2900
Mailing Address - Street 1:37 GATEWAY BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-7395
Mailing Address - Country:US
Mailing Address - Phone:706-935-2900
Mailing Address - Fax:706-935-2904
Practice Address - Street 1:37 GATEWAY BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-7395
Practice Address - Country:US
Practice Address - Phone:706-935-2900
Practice Address - Fax:706-935-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012927261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental