Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 44056 | CA |
NPI | 1093921140 |
---|---|
Provider Name | Dr. Richard Allan Penman II |
First Address | Carlsbad, CA 92008-1607 |
Second Address | Carlsbad, CA 92008-1607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/07/2007 |