Provider Demographics
NPI:1518134477
Name:MARK A PENSHORN, DDS, PA
Entity Type:Organization
Organization Name:MARK A PENSHORN, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:PENSHORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-659-1379
Mailing Address - Street 1:2501 FM 3009
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-2714
Mailing Address - Country:US
Mailing Address - Phone:210-659-1379
Mailing Address - Fax:210-659-6215
Practice Address - Street 1:2501 FM 3009
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-2714
Practice Address - Country:US
Practice Address - Phone:210-659-1379
Practice Address - Fax:210-659-6215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty