Healthcare Provider Details

I. General information

NPI: 1558333989
Provider Name (Legal Business Name): ROBERT JOSEPH PEPPETTI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MAIN ST
PORTAGE PA
15946-1539
US

IV. Provider business mailing address

PO BOX 193
PORTAGE PA
15946-0193
US

V. Phone/Fax

Practice location:
  • Phone: 814-736-3600
  • Fax:
Mailing address:
  • Phone: 814-736-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS018601L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: