Provider Demographics
NPI:1700956067
Name:REPPERMUND, JAMES L (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:REPPERMUND
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 1:1376 PITTSBURGH RD
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:PA
Mailing Address - Zip Code:16059
Mailing Address - Country:US
Mailing Address - Phone:724-898-2377
Mailing Address - Fax:724-898-2557
Practice Address - Street 1:1376 PITTSBURGH RD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:PA
Practice Address - Zip Code:16059
Practice Address - Country:US
Practice Address - Phone:724-898-2377
Practice Address - Fax:724-898-2557
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA025546L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARE486177OtherPENNA BLUE SHEILD
PARE486177OtherUNITED CONCORDIA