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General NPI Number Information
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NPI Number | 1629098199
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Entity Type | Organization
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Legal Business Name | DAVID B PEMBERTON DDS PC
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 101 COWARDIN AVENUE SUITE 303
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City | RICHMOND
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State | VA
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Zip | 23224
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Country | US
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Telephone | 804-233-6811
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Fax | 804-230-0980
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Provider Business Mailing Address
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Address Line | 101 COWARDIN AVENUE SUITE 303
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City | RICHMOND
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State | VA
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Zip | 23224
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Country | US
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Telephone | 804-233-6811
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Fax | 804-230-0980
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Authorized Official
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Title or Position | DOCTOR OF DENTAL SURGERY
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Name | DR. DAVID B PEMBERTON
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Credential | DDS
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Telephone | 804-233-6811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401005552
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License Number State | VA
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