Provider Demographics
NPI:1518044486
Name:PEPA, LAURA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:PEPA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 SADLER
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092
Mailing Address - Country:US
Mailing Address - Phone:586-615-2590
Mailing Address - Fax:
Practice Address - Street 1:16555 TEN MILE RD
Practice Address - Street 2:RIVIERA PLAZA GREAT EXPRESSIONS DENTAL
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021
Practice Address - Country:US
Practice Address - Phone:586-778-3838
Practice Address - Fax:586-778-3513
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist