Healthcare Provider Details

I. General information

NPI: 1699757500
Provider Name (Legal Business Name): DAVID C. PEPPERS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MORROW ST N
MENA AR
71953-2514
US

IV. Provider business mailing address

209 MORROW ST N P.O. BOX 197
MENA AR
71953-2514
US

V. Phone/Fax

Practice location:
  • Phone: 479-394-5920
  • Fax: 479-437-3454
Mailing address:
  • Phone: 479-394-5920
  • Fax: 479-394-7273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3444
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: