Basic Information
| Provider Information | |||||||||
| NPI: | 1780138222 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENDER | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3793 ROUTE 394 | ||||||||
| Address2: | |||||||||
| City: | ASHVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147109749 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 107 INSTITUTE ST | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147016628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164844334 | ||||||||
| FaxNumber: | 7164844335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2016 | ||||||||
| LastUpdateDate: | 10/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 30.24864 | OH | N | Dental Providers | Dentist | 1223G0001X | 2901022056 | MI | N | Dental Providers | Dentist | General Practice | 1223G0001X | 06012 | NY | N | Dental Providers | Dentist | General Practice | 122300000X | 06012 | NY | Y | Dental Providers | Dentist |
No ID Information.