Brian B Penly, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

08708 Issued in IA

Practice address

3549 11TH Ave
Council Bluffs, IA 51501-5641

Phone

(712) 328-0708

Fax

(712) 328-8991

NPI assigned

Jun 3, 2010

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

Enrolled in NE

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.

Enrollment records 1

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 and National Provider Directory roles.

• Associate Dentists, P.C.

  • General Practice Dentistry
  • Council Bluffs, IA
  • NPI 1447249230
  NPD (past)
• DW Dental LLC

  dba Associate Dentists PC

  • Dental Clinic/Center
  • Council Bluffs, IA
  • NPI 1740005321
  NPD (past)

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

{
    "created_epoch": "1275523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277251200000",
    "number": "1942520655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3549 11TH AVE",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515015641",
            "telephone_number": "712-328-0708",
            "fax_number": "712-328-8991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3549 11TH AVE",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515015641",
            "telephone_number": "712-328-0708",
            "fax_number": "712-328-8991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENLY",
        "first_name": "BRIAN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-03",
        "last_updated": "2010-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IA",
            "license": "08708",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NE",
            "license": "6888",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherri Sue Payne, CRNP
• Traci Michelle Payne, RDH
• Raymond Peak
• Katie Marie Peck, M.S.
• Sharlene E Pekny, M.S. CCC-A
• Constance Penzotti, PHARMD
• Jeremy P Pepin, M.D.
• Ashley Peregrine
• Taylor Perez
• Jayne Perfect, LMHC/LIMHP

• Dentist in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Dentist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2010; 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.

Verify at the official NPI Registry.