Healthcare Provider Details

I. General information

NPI: 1235152786
Provider Name (Legal Business Name): ROBERT CHARLES KUEPPER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SHEEP DAVIS RD
PEMBROKE NH
03275-3702
US

IV. Provider business mailing address

5 SHEEP DAVIS RD
PEMBROKE NH
03275-3702
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-7831
  • Fax: 603-224-8549
Mailing address:
  • Phone: 603-224-7831
  • Fax: 603-224-8549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1528
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: