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General NPI Number Information
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NPI Number | 1932774056
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Entity Type | Individual
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Provider Name | JESSICA MARIE PIEPENBRINK DMD
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Gender | Female
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 2850 24TH ST
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City | ROCK ISLAND
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State | IL
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Zip | 61201-5308
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Country | US
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Telephone | 309-786-7782
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Fax |
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Provider Business Mailing Address
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Address Line | 2850 24TH ST
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City | ROCK ISLAND
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State | IL
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Zip | 61201-5308
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Country | US
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Telephone | 309-786-7782
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021.003099
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DDS-09842
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019.031822
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License Number State | IL
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