Provider Demographics
NPI:1386871697
Name:PENLAND, SAMUEL ROSS (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ROSS
Last Name:PENLAND
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:430 WEST 20TH ST SUITE#7
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-3732
Mailing Address - Country:US
Mailing Address - Phone:828-464-9220
Mailing Address - Fax:828-464-9234
Practice Address - Street 1:430 W 20TH ST STE 7
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3732
Practice Address - Country:US
Practice Address - Phone:828-464-9220
Practice Address - Fax:828-464-9234
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2011-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC91701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry