Healthcare Provider Details

I. General information

NPI: 1750492997
Provider Name (Legal Business Name): MICHAEL E PIEPENBRING DMD MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 MEMORIAL LANE SUITE B
GEORGETOWN SC
29440
US

IV. Provider business mailing address

1109 MEMORIAL LANE SUITE B
GEORGETOWN SC
29440
US

V. Phone/Fax

Practice location:
  • Phone: 843-546-0173
  • Fax: 843-545-8343
Mailing address:
  • Phone: 843-546-0173
  • Fax: 843-545-8343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0338
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0522
License Number StateSC

VIII. Authorized Official

Name: MICHAEL EUGENE PIEPENBRING
Title or Position: PRESIDENT
Credential: DMD MS
Phone: 843-546-0173