Provider Demographics
NPI:1891997185
Name:PENFIELD, JAMES V
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:V
Last Name:PENFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 672514
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-2514
Mailing Address - Country:US
Mailing Address - Phone:907-688-7874
Mailing Address - Fax:907-622-7876
Practice Address - Street 1:12641 OLD GLENN HWY SUITE 101
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577
Practice Address - Country:US
Practice Address - Phone:907-688-7874
Practice Address - Fax:907-688-7876
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD5399Medicaid