Provider Demographics
NPI:1427255942
Name:PENNINGTON, DISHA HADI (DDS)
Entity type:Individual
Prefix:DR
First Name:DISHA
Middle Name:HADI
Last Name:PENNINGTON
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 1:405 ROTHROCK RD
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-3125
Mailing Address - Country:US
Mailing Address - Phone:330-668-9830
Mailing Address - Fax:330-668-9850
Practice Address - Street 1:405 ROTHROCK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-3125
Practice Address - Country:US
Practice Address - Phone:330-668-9830
Practice Address - Fax:330-668-9850
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist