MEDICARE: RICHARD R PENCE DDS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	3590	NC

General Provider Information

NPI Number	:	1275752180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD R PENCE DDS PA

Provider Business Mailing Address
First Line	:	7482 WATERSIDE CROSSING BLVD STE 102
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-3006
Country	:	US
Telephone Number	:	704-489-8221
Fax Number	:	704-822-0448

Provider Business Practice Location Address
First Line	:	7482 WATERSIDE CROSSING BLVD STE 102
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-3006
Country	:	US
Telephone Number	:	704-489-8221
Fax Number	:	704-822-0448

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD RAYMOND PENCE
Credential	:	DDS, MAGD
Telephone Number	:	704-489-8221

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	11/08/2011

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