Provider Demographics
NPI:1851333496
Name:PENTA, SAMUEL ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ANTHONY
Last Name:PENTA
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 1:302 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-2389
Mailing Address - Country:US
Mailing Address - Phone:781-233-0344
Mailing Address - Fax:
Practice Address - Street 1:302 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-2389
Practice Address - Country:US
Practice Address - Phone:781-233-0344
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist