Provider Demographics
NPI:1760576532
Name:PENTERSON, ROBERT N (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:N
Last Name:PENTERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5954 HARBOUR PARK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2163
Mailing Address - Country:US
Mailing Address - Phone:804-739-1600
Mailing Address - Fax:804-739-9035
Practice Address - Street 1:5954 HARBOUR PARK DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2163
Practice Address - Country:US
Practice Address - Phone:804-739-1600
Practice Address - Fax:804-739-9035
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA05777122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA553313OtherUNITED CONCORDIA PROVIDER
VA182413OtherANTHEM PROVIDER NO.
VA562306674OtherDELTA DENTAL PROVIDER NO.