Provider Demographics
NPI:1205014487
Name:MICHAEL C. JEPPSON DENTAL P.C.
Entity Type:Organization
Organization Name:MICHAEL C. JEPPSON DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:JEPPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-628-9600
Mailing Address - Street 1:1224 S RIVER RD BLDG D
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8285
Mailing Address - Country:US
Mailing Address - Phone:435-628-9600
Mailing Address - Fax:435-688-1849
Practice Address - Street 1:1224 S RIVER RD BLDG D
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8285
Practice Address - Country:US
Practice Address - Phone:435-628-9600
Practice Address - Fax:435-688-1849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-09
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5262668-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty