Provider Demographics
NPI:1962585364
Name:JAMES L REPPERMUND DMD PC
Entity type:Organization
Organization Name:JAMES L REPPERMUND DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:REPPERMUND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-898-2377
Mailing Address - Street 1:1376 PITTSBURGH RD
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:PA
Mailing Address - Zip Code:16059
Mailing Address - Country:US
Mailing Address - Phone:724-898-2377
Mailing Address - Fax:724-898-2557
Practice Address - Street 1:1376 PITTSBURGH RD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:PA
Practice Address - Zip Code:16059
Practice Address - Country:US
Practice Address - Phone:724-898-2377
Practice Address - Fax:724-898-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA025546L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARE486177OtherUNITED CONCORDIA
PARE486177OtherPENNA BLUE SHEILD