Provider Demographics
NPI:1316236375
Name:PEPPER, SHANDRA SUKTALORDCHEEP (DDS)
Entity type:Individual
Prefix:
First Name:SHANDRA
Middle Name:SUKTALORDCHEEP
Last Name:PEPPER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHANDRA
Other - Middle Name:
Other - Last Name:SUKTALORDCHEEP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:318 SUGAR LOAF DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-7951
Mailing Address - Country:US
Mailing Address - Phone:661-266-1192
Mailing Address - Fax:
Practice Address - Street 1:19255 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91387-1472
Practice Address - Country:US
Practice Address - Phone:661-276-8755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA629481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry