# DAVID R. TEBBENKAMP DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114127537
- **Authorized official:** MR. DAVID RAY TEBBENKAMP DDS (DENTIST/PRESIDENT)
- **Authorized official phone:** (276) 388-3511

## Contact information

- **Practice address:** 21788 AZEN RD, DAMASCUS, VA 24236-4236
- **Practice address phone:** (276) 388-3511
- **Practice address fax:** (276) 388-3163
- **Mailing address:** 21788 AZEN RD, DAMASCUS, VA 24236-4236
- **Mailing address phone:** (276) 388-3511
- **Mailing address fax:** (276) 388-3163

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 0401004941 | VA | Yes |

## Other

- **Enumeration date:** 07/24/2007
- **Last updated:** 07/24/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 228633 | ANTHEM-BLUE CROSS BLUE SH | VA |