Provider Demographics
NPI:1104013937
Name:JEPPSON, MICHAEL CALVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CALVIN
Last Name:JEPPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 E 2860 S
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4707
Mailing Address - Country:US
Mailing Address - Phone:801-518-4998
Mailing Address - Fax:
Practice Address - Street 1:1224 S RIVER RD BLDG D
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8285
Practice Address - Country:US
Practice Address - Phone:435-628-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5262668-9923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist