Provider Demographics
NPI:1962550475
Name:PEMBERTON, BERKELEY MILLER (DDS)
Entity type:Individual
Prefix:DR
First Name:BERKELEY
Middle Name:MILLER
Last Name:PEMBERTON
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 1:1380 LITTLE SORRELL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-7372
Mailing Address - Country:US
Mailing Address - Phone:540-437-3962
Mailing Address - Fax:
Practice Address - Street 1:1380 LITTLE SORRELL DR STE 100
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-7372
Practice Address - Country:US
Practice Address - Phone:540-437-3962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010041411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice