Provider Demographics
NPI:1245481282
Name:CRAIN, PENNY PAYNE (DMD)
Entity type:Individual
Prefix:DR
First Name:PENNY
Middle Name:PAYNE
Last Name:CRAIN
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 1:115 E FLAGET ST
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1517
Mailing Address - Country:US
Mailing Address - Phone:502-348-9400
Mailing Address - Fax:502-348-9520
Practice Address - Street 1:115 E FLAGET ST
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1517
Practice Address - Country:US
Practice Address - Phone:502-348-9400
Practice Address - Fax:502-348-9520
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 7024122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist