Individual
DR. ROBERT N PENTERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5954 HARBOUR PARK DR, MIDLOTHIAN, VA 23112-2163
(804) 739-1600
(804) 739-9035
Mailing address
5954 HARBOUR PARK DR, MIDLOTHIAN, VA 23112-2163
(804) 739-1600
(804) 739-9035
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
05777
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
182413
ANTHEM PROVIDER NO.
VA
01
—
553313
UNITED CONCORDIA PROVIDER
VA
01
—
562306674
DELTA DENTAL PROVIDER NO.
VA
Enumeration date
10/03/2006
Last updated
07/01/2014
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