Provider Demographics
NPI:1427076231
Name:PENN, JOSEPH H (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:H
Last Name:PENN
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 1:4405 STARKEY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0617
Mailing Address - Country:US
Mailing Address - Phone:540-772-2913
Mailing Address - Fax:540-989-6623
Practice Address - Street 1:4405 STARKEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0617
Practice Address - Country:US
Practice Address - Phone:540-772-2913
Practice Address - Fax:540-989-6623
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010042831223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics