# DAVID B PEMBERTON DDS PC

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

## Provider details

- **NPI number:** 1629098199
- **Authorized official:** DR. DAVID B PEMBERTON DDS (DOCTOR OF DENTAL SURGERY)
- **Authorized official phone:** (804) 233-6811

## Contact information

- **Practice address:** 101 COWARDIN AVENUE, SUITE 303, RICHMOND, VA 23224
- **Practice address phone:** (804) 233-6811
- **Practice address fax:** (804) 230-0980
- **Mailing address:** 101 COWARDIN AVENUE, SUITE 303, RICHMOND, VA 23224
- **Mailing address phone:** (804) 233-6811
- **Mailing address fax:** (804) 230-0980

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 0401005552 | VA | Yes |

## Other

- **Enumeration date:** 07/20/2006
- **Last updated:** 09/02/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00762638 | UNITED CONCORDIA | — |
| 01 | — | 077681 | ANTHEM | VA |
| 01 | — | 172260 | ANTHEM | VA |
| 05 | — | 7815042 | — | VA |