Provider Demographics
NPI:1073947958
Name:JEPPSON ENDODONTICS, PLLC
Entity type:Organization
Organization Name:JEPPSON ENDODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEPPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-357-4826
Mailing Address - Street 1:101 E MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-2000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 E MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-2000
Practice Address - Country:US
Practice Address - Phone:208-357-4826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8121225-9921261QD0000X
UT8121225-9922261QD0000X
IDD-4167-EN261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental