1124113642 NPI number — MS. SHARON MOSS PEPPER R.D.H.

Table of content: MS. SHARON MOSS PEPPER R.D.H. (NPI 1124113642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124113642 NPI number — MS. SHARON MOSS PEPPER R.D.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEPPER
Provider First Name:
SHARON
Provider Middle Name:
MOSS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
R.D.H.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PEPPER
Provider Other First Name:
SHERRY
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.D.H.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1124113642
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NF/SG VETERANS HEALTH SYSTEM 619 S. MARION AVE
Provider Second Line Business Mailing Address:
(160) DENTAL
Provider Business Mailing Address City Name:
LAKE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32025-5808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-755-3016
Provider Business Mailing Address Fax Number:
386-754-7259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NF/SG VETERANS HEALTH SYSTEM 619 S. MARION AVE
Provider Second Line Business Practice Location Address:
(160) DENTAL
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32025-5808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-755-3016
Provider Business Practice Location Address Fax Number:
386-754-7259
Provider Enumeration Date:
10/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  4719 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)