Provider Demographics
NPI:1699888362
Name:KEPNER, GEORGE R (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:R
Last Name:KEPNER
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:PO BOX 338
Mailing Address - Street 2:66 CENTER ST.
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-0338
Mailing Address - Country:US
Mailing Address - Phone:781-293-3936
Mailing Address - Fax:781-293-5081
Practice Address - Street 1:66 CENTER ST.
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-0338
Practice Address - Country:US
Practice Address - Phone:781-293-3936
Practice Address - Fax:781-293-5081
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice