Provider Demographics
NPI:1780747790
Name:PENNINGTON, JEFFREY NEIL (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:NEIL
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 THE GREENS WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2449
Mailing Address - Country:US
Mailing Address - Phone:904-280-3347
Mailing Address - Fax:904-285-0207
Practice Address - Street 1:1541 THE GREENS WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-2449
Practice Address - Country:US
Practice Address - Phone:904-280-3347
Practice Address - Fax:904-285-0207
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL162021223G0001X
GA0126851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice