Provider Demographics
NPI:1700984374
Name:PEPIN, KEVIN J (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:PEPIN
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 1:302 HALL AVENUE
Mailing Address - Street 2:
Mailing Address - City:CRIVITZ
Mailing Address - State:WI
Mailing Address - Zip Code:54114-1442
Mailing Address - Country:US
Mailing Address - Phone:715-854-3888
Mailing Address - Fax:715-854-3889
Practice Address - Street 1:302 HALL AVENUE
Practice Address - Street 2:
Practice Address - City:CRIVITZ
Practice Address - State:WI
Practice Address - Zip Code:54114-1442
Practice Address - Country:US
Practice Address - Phone:715-854-3888
Practice Address - Fax:715-854-3889
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice