Provider Demographics
NPI:1639403033
Name:REPPAS, SERAFIM N (DDS, MD)
Entity Type:Individual
Prefix:
First Name:SERAFIM
Middle Name:N
Last Name:REPPAS
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4441
Mailing Address - Country:US
Mailing Address - Phone:330-678-6564
Mailing Address - Fax:330-676-6973
Practice Address - Street 1:1551 S WATER ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4441
Practice Address - Country:US
Practice Address - Phone:330-678-6564
Practice Address - Fax:330-676-6973
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0370671223S0112X
OH30.0236501223S0112X
OH35.099912204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery