Organization
DAVID R. TEBBENKAMP DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID RAY TEBBENKAMP DDS (DENTIST/PRESIDENT)
(276) 388-3511
Entity
Organization
Contact information
Practice address
21788 AZEN RD, DAMASCUS, VA 24236-4236
(276) 388-3511
(276) 388-3163
Mailing address
21788 AZEN RD, DAMASCUS, VA 24236-4236
(276) 388-3511
(276) 388-3163
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401004941
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
228633
ANTHEM-BLUE CROSS BLUE SH
VA
Enumeration date
07/24/2007
Last updated
07/24/2007
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