Provider Demographics
NPI:1992860753
Name:PENNINGTON, ANGELA PAIGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:PAIGE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MAGGIE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863
Mailing Address - Country:US
Mailing Address - Phone:662-488-9905
Mailing Address - Fax:662-488-0020
Practice Address - Street 1:29 MAGGIE DRIVE
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863
Practice Address - Country:US
Practice Address - Phone:662-488-9905
Practice Address - Fax:662-488-0020
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS262991122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist