Jeremiah David Penberthy, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN10000823 Issued in MA

Practice address

635 Albany St
Boston, MA 02118-3550

Phone

(617) 358-8300

NPI assigned

Apr 23, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Adults & Children Dental Care

  • General Practice Dentistry
  • Lynn, MA
  • NPI 1568539807
  NPD (past)

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

{
    "created_epoch": "1745366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770595200000",
    "number": "1386431310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "167 WINTHROP SHORE DR UNIT 2",
            "city": "WINTHROP",
            "state": "MA",
            "postal_code": "021521247",
            "telephone_number": "208-771-1172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 ALBANY ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021183550",
            "telephone_number": "617-358-8300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "140 Union St Ste 303",
            "address_purpose": "LOCATION",
            "city": "Lynn",
            "state": "MA",
            "postal_code": "019011326",
            "country_code": "US",
            "telephone_number": "781-592-4438",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "123 Revere St",
            "address_purpose": "LOCATION",
            "city": "Revere",
            "state": "MA",
            "postal_code": "021514439",
            "country_code": "US",
            "telephone_number": "617-377-7924",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "999 Saratoga St",
            "address_purpose": "LOCATION",
            "city": "East Boston",
            "state": "MA",
            "postal_code": "021281238",
            "country_code": "US",
            "telephone_number": "617-569-2761",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENBERTHY",
        "first_name": "JEREMIAH",
        "middle_name": "DAVID",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-23",
        "last_updated": "2026-02-09",
        "certification_date": "2026-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MA",
            "license": "DN10000823",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN10000823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Ryan A Pena, MD, PHD, MS
• Leybis Manuel Pena, RN
• Mirkeiry Pena
• Tiffanie Pena
• Tatiana Penagos, MA, MT-BC
• Skylar Penberthy, DMD
• Mary K Penckofer
• Maribeth Pender, MS
• Suzanne Pender, MD
• Shona S Pendse, MD

• General Practice Dentistry in Boston, MA
• Providers in Boston, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.