Provider Demographics
NPI:1265642086
Name:TEPPER, MARY BRADLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BRADLEY
Last Name:TEPPER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 E NATIONAL CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-3230
Mailing Address - Country:US
Mailing Address - Phone:843-664-2634
Mailing Address - Fax:843-664-2687
Practice Address - Street 1:714 E NATIONAL CEMETERY RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-3230
Practice Address - Country:US
Practice Address - Phone:843-664-2634
Practice Address - Fax:843-664-2687
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC-25511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice