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General NPI Number Information
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NPI Number | 1275752180
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Entity Type | Organization
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Legal Business Name | RICHARD R PENCE DDS PA
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 7482 WATERSIDE CROSSING BLVD STE 102
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City | DENVER
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State | NC
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Zip | 28037-3006
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Country | US
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Telephone | 704-489-8221
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Fax | 704-822-0448
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Provider Business Mailing Address
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Address Line | 7482 WATERSIDE CROSSING BLVD STE 102
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City | DENVER
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State | NC
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Zip | 28037-3006
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Country | US
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Telephone | 704-489-8221
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Fax | 704-822-0448
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD RAYMOND PENCE
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Credential | DDS, MAGD
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Telephone | 704-489-8221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3590
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License Number State | NC
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