Healthcare Provider Details

I. General information

NPI: 1124210372
Provider Name (Legal Business Name): PAMELA F. REGIMBAL D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8266 JUPITER DR
MECHANICSVILLE VA
23116-2812
US

IV. Provider business mailing address

8266 JUPITER DRIVE
MECHANICSVILLE VA
23116-2811
US

V. Phone/Fax

Practice location:
  • Phone: 804-746-7720
  • Fax: 804-746-8035
Mailing address:
  • Phone: 804-746-7720
  • Fax: 804-746-8035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401007077
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: