Individual
DR. BRIAN PENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1615 TRUEMPER ST BLDG 6418, LACKLAND AFB, TX 78236-5511
(210) 292-0694
Mailing address
1615 TRUEMPER ST BLDG 6418, LACKLAND AFB, TX 78236-5511
(210) 292-0694
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D11755
MN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
34385
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D11755
DENTIST
MN
Enumeration date
08/19/2005
Last updated
12/30/2021
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