Provider Demographics
NPI:1124113642
Name:PEPPER, SHARON MOSS (RDH)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:MOSS
Last Name:PEPPER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:M
Other - Last Name:PEPPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:NF/SG VETERANS HEALTH SYSTEM 619 S. MARION AVE
Mailing Address - Street 2:(160) DENTAL
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-5808
Mailing Address - Country:US
Mailing Address - Phone:386-755-3016
Mailing Address - Fax:386-754-7259
Practice Address - Street 1:NF/SG VETERANS HEALTH SYSTEM 619 S. MARION AVE
Practice Address - Street 2:(160) DENTAL
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5808
Practice Address - Country:US
Practice Address - Phone:386-755-3016
Practice Address - Fax:386-754-7259
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4719124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist