Provider Demographics
NPI:1780138222
Name:PENDER, ERIN E (DDS)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:PENDER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3793 ROUTE 394
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14710-9749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 INSTITUTE ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6628
Practice Address - Country:US
Practice Address - Phone:716-484-4334
Practice Address - Fax:716-484-4335
Is Sole Proprietor?:No
Enumeration Date:2016-08-13
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.24864122300000X
MI29010220561223G0001X
NY060121223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice