Provider Demographics
NPI:1528299153
Name:PENNAU, KARL ERDMAN (DDS)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:ERDMAN
Last Name:PENNAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5745 ERINDALE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8926
Mailing Address - Country:US
Mailing Address - Phone:719-473-2650
Mailing Address - Fax:719-473-2508
Practice Address - Street 1:5745 ERINDALE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8926
Practice Address - Country:US
Practice Address - Phone:719-473-2650
Practice Address - Fax:719-473-2508
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002018141223S0112X
WADE602138291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery