Timothy Walter Penberthy, D.D.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

D-1930-EN Issued in ID

Practice address

509 W Hanley Ave
Suite # 2
Coeur D Alene, ID 83815-8994

Phone

(208) 664-8622

NPI assigned

Jan 18, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 20, 2025 through Mar 20, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northwest Endodontics PC

  • Endodontics
  • Coeur d'Alene, ID
  • NPI 1972660769
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285786194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 W HANLEY AVE",
            "address_2": "SUITE # 2",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158994",
            "telephone_number": "208-664-8622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 W HANLEY AVE",
            "address_2": "SUITE # 2",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158994",
            "telephone_number": "208-664-8622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENBERTHY",
        "first_name": "TIMOTHY",
        "middle_name": "WALTER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "ID",
            "license": "D-1930-EN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annaliese Elizabeth Pelletier, LCSW
• Courtney Alisha Pellow
• Nicole W Pelly
• Holly Beth Pena, ARNP
• Brittney Ann Penberthy, D.D.S
• Brett A Penney, M.D.
• Elaina Penney, RN
• Michelle Pereira
• Robert Pereyra, MD
• Performance Modalities Inc (Performance Home Medical)

• Endodontics in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Endodontics in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.