Provider Demographics
NPI:1386047231
Name:JEPSON, KRISTEN ANN (RDH)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ANN
Last Name:JEPSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 749
Mailing Address - Street 2:
Mailing Address - City:CLATSKANIE
Mailing Address - State:OR
Mailing Address - Zip Code:97016
Mailing Address - Country:US
Mailing Address - Phone:503-728-2114
Mailing Address - Fax:503-728-3320
Practice Address - Street 1:400 S.W. BELAIR DRIVE
Practice Address - Street 2:
Practice Address - City:CLATSKANIE
Practice Address - State:OR
Practice Address - Zip Code:97016
Practice Address - Country:US
Practice Address - Phone:503-728-2114
Practice Address - Fax:503-728-3322
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5042124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist