# PENNY C WALPOLE DDS PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376572511
- **Authorized official:** DR. PENNY C WALPOLE DDS PS (PRESIDENT)
- **Authorized official phone:** (509) 922-4809

## Contact information

- **Practice address:** 15701 E SPRAGUE AVE, STE F, VERADALE, WA 99037
- **Practice address phone:** (509) 922-4809
- **Practice address fax:** (509) 922-8718
- **Mailing address:** 15701 E SPRAGUE AVE, STE F, VERADALE, WA 99037
- **Mailing address phone:** (509) 922-4809
- **Mailing address fax:** (509) 922-8718

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE7995 | WA | Yes |

## Other

- **Enumeration date:** 07/01/2006
- **Last updated:** 08/22/2020