Provider Demographics
NPI:1629139191
Name:PENNEY, PATRICK ALLAN (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:ALLAN
Last Name:PENNEY
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 1:1675 ALHAMBRA BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7047
Mailing Address - Country:US
Mailing Address - Phone:916-453-1808
Mailing Address - Fax:816-453-1426
Practice Address - Street 1:1675 ALHAMBRA BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7047
Practice Address - Country:US
Practice Address - Phone:916-453-1808
Practice Address - Fax:816-453-1426
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist