Provider Demographics
NPI:1861400855
Name:PENNA, ROBERT A (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:PENNA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2710 CENTERVILLE RD STE 215
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1664
Mailing Address - Country:US
Mailing Address - Phone:302-998-8783
Mailing Address - Fax:302-998-8786
Practice Address - Street 1:2710 CENTERVILLE RD STE 215
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1664
Practice Address - Country:US
Practice Address - Phone:302-998-8783
Practice Address - Fax:302-998-8786
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029074L1223X0400X
DEG100010801223X0400X
DEGI00010801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics