Provider Demographics
NPI:1396753984
Name:PAPPAS, PAMELA L (DDS)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:PAPPAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:CROWDER
Other - Last Name:PAPPAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:50 INDUSTRIAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013
Mailing Address - Country:US
Mailing Address - Phone:269-427-7937
Mailing Address - Fax:269-427-5180
Practice Address - Street 1:800 M-139
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022
Practice Address - Country:US
Practice Address - Phone:269-927-5300
Practice Address - Fax:269-927-1956
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4246401Medicaid