Provider Demographics
NPI:1083709034
Name:JEPPE, WILLIAM GUY JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GUY
Last Name:JEPPE
Suffix:JR
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 1170
Mailing Address - Street 2:
Mailing Address - City:HOMEDALE
Mailing Address - State:ID
Mailing Address - Zip Code:83628
Mailing Address - Country:US
Mailing Address - Phone:208-337-4383
Mailing Address - Fax:208-337-5715
Practice Address - Street 1:115 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:HOMEDALE
Practice Address - State:ID
Practice Address - Zip Code:83628
Practice Address - Country:US
Practice Address - Phone:208-337-4383
Practice Address - Fax:208-337-5715
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-16751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID66944OtherBLUE CROSS