Provider Demographics
NPI:1013351824
Name:S. ROSS PENLAND DMD PA
Entity Type:Organization
Organization Name:S. ROSS PENLAND DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:PENLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-855-3779
Mailing Address - Street 1:1781 TATE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4251
Mailing Address - Country:US
Mailing Address - Phone:828-855-3779
Mailing Address - Fax:828-855-3781
Practice Address - Street 1:1781 TATE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4251
Practice Address - Country:US
Practice Address - Phone:828-855-3779
Practice Address - Fax:828-855-3781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC91701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty