Provider Demographics
NPI:1710054010
Name:PENRY, WILLIAM GASTON JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GASTON
Last Name:PENRY
Suffix:JR
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 1:241 EAST CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292
Mailing Address - Country:US
Mailing Address - Phone:336-249-6848
Mailing Address - Fax:336-249-7360
Practice Address - Street 1:241 EAST CENTER STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292
Practice Address - Country:US
Practice Address - Phone:336-249-6848
Practice Address - Fax:336-249-7360
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4733 NC122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist