# NORTHWEST ENDODONTICS PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Timothy W Penberthy DDS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972660769
- **Authorized official:** MR. TIMOTHY WALTHER PENBERTHY DR (OWNER)
- **Authorized official phone:** (208) 667-8622

## Contact information

- **Practice address:** 509 W HANLEY, STE 202, COEUR D ALENE, ID 83815
- **Practice address phone:** (208) 667-8622
- **Practice address fax:** (208) 664-2402
- **Mailing address:** 509 W HANLEY, STE 202, COEUR D ALENE, ID 83815
- **Mailing address phone:** (208) 667-8622
- **Mailing address fax:** (208) 664-2402

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | D1930EN | ID | Yes |

## Other

- **Enumeration date:** 01/02/2007
- **Last updated:** 08/04/2008