Provider Demographics
NPI:1750492997
Name:MICHAEL E PIEPENBRING DMD MS PC
Entity Type:Organization
Organization Name:MICHAEL E PIEPENBRING DMD MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PIEPENBRING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:843-546-0173
Mailing Address - Street 1:1109 MEMORIAL LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440
Mailing Address - Country:US
Mailing Address - Phone:843-546-0173
Mailing Address - Fax:843-545-8343
Practice Address - Street 1:1109 MEMORIAL LANE
Practice Address - Street 2:SUITE B
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440
Practice Address - Country:US
Practice Address - Phone:843-546-0173
Practice Address - Fax:843-545-8343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC05221223E0200X
SC03381223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1912188525Medicaid
SCZA9782Medicaid