Provider Demographics
NPI:1972684793
Name:DUNLAP, PENELOPE LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:LYNN
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PENELOPE
Other - Middle Name:LYNN
Other - Last Name:WEHNERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:240 HOOSIER DR.
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703
Mailing Address - Country:US
Mailing Address - Phone:260-624-3355
Mailing Address - Fax:260-667-9966
Practice Address - Street 1:240 HOOSIER DR.
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703
Practice Address - Country:US
Practice Address - Phone:260-624-3355
Practice Address - Fax:260-667-9966
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120098901223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200321750Medicaid