Provider Demographics
NPI:1669783262
Name:PENNA, NICHOL IRENE (DMD)
Entity type:Individual
Prefix:DR
First Name:NICHOL
Middle Name:IRENE
Last Name:PENNA
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 1:361 SEASIDE AVE
Mailing Address - Street 2:APT 201
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3412
Mailing Address - Country:US
Mailing Address - Phone:207-939-8746
Mailing Address - Fax:
Practice Address - Street 1:618 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9618
Practice Address - Country:US
Practice Address - Phone:207-883-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN41481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice