Richard Raymond Pence, DDS MAGD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3590 Issued in NC

Practice address

111 Doctors Park
Lincolnton, NC 28092-4407

Phone

(704) 735-8228

Fax

(704) 735-2829

NPI assigned

May 24, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255334223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 DOCTORS PARK",
            "city": "LINCOLNTON",
            "state": "NC",
            "postal_code": "280924407",
            "telephone_number": "704-735-8228",
            "fax_number": "704-735-2829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 DOCTORS PARK",
            "city": "LINCOLNTON",
            "state": "NC",
            "postal_code": "280924407",
            "telephone_number": "704-735-8228",
            "fax_number": "704-735-2829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENCE",
        "first_name": "RICHARD",
        "middle_name": "RAYMOND",
        "name_prefix": "Dr.",
        "credential": "DDS MAGD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "3590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC LICENSE NUMBER",
            "identifier": "3590",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Robin Owings, D.C.
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• Amy Leigh Peacock
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• Phoenix Counseling Center
• Phoenix Counseling Center

• General Practice Dentistry in Lincolnton, NC
• Providers in Lincolnton, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.