Provider Demographics
NPI:1306987441
Name:PENHALL, ORVAL J (DMD)
Entity type:Individual
Prefix:DR
First Name:ORVAL
Middle Name:J
Last Name:PENHALL
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 1:1116 SANDSTONE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-1162
Mailing Address - Country:US
Mailing Address - Phone:724-836-5172
Mailing Address - Fax:
Practice Address - Street 1:1215 N GREENGATE DR # 341
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-4030
Practice Address - Country:US
Practice Address - Phone:724-836-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS18175L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist