Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 4641 | SC |
NPI | 1033402896 |
---|---|
Provider Name | Dr. Daniel Ryan Pennella |
First Address | Lexington, SC 29072-2806 |
Second Address | Lexington, SC 29072-2806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2011 |
Last Update Date | 25/05/2011 |