Provider Demographics
NPI:1588744197
Name:PENNY, ROBERT E (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:PENNY
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 1:1721-01 EBENEZER ROAD
Mailing Address - Street 2:STE 105
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-4103
Mailing Address - Country:US
Mailing Address - Phone:803-328-0175
Mailing Address - Fax:803-328-0176
Practice Address - Street 1:1721-01 EBENEZER ROAD
Practice Address - Street 2:STE 105
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-4103
Practice Address - Country:US
Practice Address - Phone:803-328-0175
Practice Address - Fax:803-328-0176
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20801223P0300X
NC2000014001791223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics