Provider Demographics
NPI:1609967462
Name:PENROD, ROBERT ELEE (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ELEE
Last Name:PENROD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MULLIGAN CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-5010
Mailing Address - Country:US
Mailing Address - Phone:352-219-7494
Mailing Address - Fax:
Practice Address - Street 1:11206 SW 93RD COURT RD STE 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-5252
Practice Address - Country:US
Practice Address - Phone:352-390-2219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 168141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice