Organization
NORTHWEST ENDODONTICS PC
Active
Other names
Timothy W Penberthy DDS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY WALTHER PENBERTHY DR (OWNER)
(208) 667-8622
Entity
Organization
Contact information
Practice address
509 W HANLEY, STE 202, COEUR D ALENE, ID 83815
(208) 667-8622
(208) 664-2402
Mailing address
509 W HANLEY, STE 202, COEUR D ALENE, ID 83815
(208) 667-8622
(208) 664-2402
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
D1930EN
ID
Other
Enumeration date
01/02/2007
Last updated
08/04/2008
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