Provider Demographics
NPI:1770579310
Name:PEPPER, LARRY (DMD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:PEPPER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:PEPPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:4700 UNION DEPOSIT RD STE 260
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3787
Mailing Address - Country:US
Mailing Address - Phone:717-909-0530
Mailing Address - Fax:717-909-0515
Practice Address - Street 1:4700 UNION DEPOSIT RD
Practice Address - Street 2:SUITE 260
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-3774
Practice Address - Country:US
Practice Address - Phone:717-540-1777
Practice Address - Fax:717-540-6857
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020731L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT27652Medicare UPIN