Provider Demographics
NPI:1497433924
Name:PEPPLER, LUCAS J (DDS)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:J
Last Name:PEPPLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 ANGEL CT UNIT 22
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-2402
Mailing Address - Country:US
Mailing Address - Phone:920-299-6712
Mailing Address - Fax:
Practice Address - Street 1:3143 STATE RD STE 100
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6964
Practice Address - Country:US
Practice Address - Phone:608-788-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001268-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist