Active NPI
Christina Penn, DMD
- Endodontics
- Brentwood, CA
National Provider Identifier
1609239557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DDS103903
- Practice address
- 1140 2ND St Ste B
Brentwood, CA 94513-2223 - Phone
- (925) 240-8111
- NPI assigned
- Mar 29, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DDS103903 | CA | Primary |
Addresses
Primary practice location
1140 2ND St Ste B
Brentwood, CA 94513-2223
Mailing address
1140 2ND St Ste B
Brentwood, CA 94513-2223
Phone (925) 240-8111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170913001320 | MA | Order and Referring Only - Dentist | 2264705292 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS103903 | CA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565481600000",
"number": "1609239557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1140 2ND ST STE B",
"city": "BRENTWOOD",
"state": "CA",
"postal_code": "945132223",
"telephone_number": "925-240-8111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1140 2ND ST STE B",
"city": "BRENTWOOD",
"state": "CA",
"postal_code": "945132223",
"telephone_number": "925-240-8111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENN",
"first_name": "CHRISTINA",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-29",
"last_updated": "2019-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "DDS103903",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brentwood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2019; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.