Provider Demographics
NPI:1780023275
Name:PENBERTHY, BRITTNEY ANN (DDS)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:ANN
Last Name:PENBERTHY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 W HANLEY AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8994
Mailing Address - Country:US
Mailing Address - Phone:208-667-8622
Mailing Address - Fax:208-664-2402
Practice Address - Street 1:509 W HANLEY AVE STE 202
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8994
Practice Address - Country:US
Practice Address - Phone:208-667-8622
Practice Address - Fax:208-664-2402
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-5941122300000X
TX30909122300000X
IDD4493-EN1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist