Provider Demographics
NPI:1568452183
Name:CHEPPA, EDWARD S (DMD, PC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:S
Last Name:CHEPPA
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:WILKINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2940
Mailing Address - Country:US
Mailing Address - Phone:412-242-1285
Mailing Address - Fax:412-247-5905
Practice Address - Street 1:714 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:WILKINSBURG
Practice Address - State:PA
Practice Address - Zip Code:15221-2940
Practice Address - Country:US
Practice Address - Phone:412-242-1285
Practice Address - Fax:412-247-5905
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021835L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2341OtherDOMINION PROVIDER NUMBER
PA159907OtherUNITED CONCORDIA PROVIDER
PA112054OtherAETNA DMO
PA000693343-0001Medicaid
PA005354OtherDORAL UPMC 4 U
PA179237OtherUNISON
PA24595-1OtherGATEWAY
WV4005155-000OtherUNYSIS