Provider Demographics
NPI:1689788804
Name:KREPS, GARY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:KREPS
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 1:9380 MCKNIGHT RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5954
Mailing Address - Country:US
Mailing Address - Phone:412-367-3222
Mailing Address - Fax:412-367-3373
Practice Address - Street 1:9380 MCKNIGHT RD
Practice Address - Street 2:SUITE 203
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5954
Practice Address - Country:US
Practice Address - Phone:412-367-3222
Practice Address - Fax:412-367-3373
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023396L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT27259Medicare UPIN