Provider Demographics
NPI:1942492335
Name:PEPPLER, MICHAEL SCOTT (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:PEPPLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3000
Mailing Address - Street 2:ATTN 91136
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-8001
Mailing Address - Country:US
Mailing Address - Phone:971-279-7414
Mailing Address - Fax:503-315-7227
Practice Address - Street 1:7430 PARK MEADOWS DR
Practice Address - Street 2:#100
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2559
Practice Address - Country:US
Practice Address - Phone:303-790-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist