Provider Demographics
NPI:1750588281
Name:DISHA HADI PENNINGTON DDS LLC
Entity type:Organization
Organization Name:DISHA HADI PENNINGTON DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DISHA
Authorized Official - Middle Name:HADI
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-668-9830
Mailing Address - Street 1:405 ROTHROCK RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-3125
Mailing Address - Country:US
Mailing Address - Phone:330-668-9830
Mailing Address - Fax:330-668-9850
Practice Address - Street 1:405 ROTHROCK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-3125
Practice Address - Country:US
Practice Address - Phone:330-668-9830
Practice Address - Fax:330-668-9850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH211291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty