Provider Demographics
NPI:1891033437
Name:LAMPROS, PENNY L (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:PENNY
Middle Name:L
Last Name:LAMPROS
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 COLONIAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-3205
Mailing Address - Country:US
Mailing Address - Phone:540-344-2758
Mailing Address - Fax:540-981-1814
Practice Address - Street 1:2114 COLONIAL AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-3205
Practice Address - Country:US
Practice Address - Phone:540-344-2758
Practice Address - Fax:540-981-1814
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010075931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics