Provider Demographics
NPI:1285035444
Name:JOHN'E JASPER EPPS, DDS, PLC
Entity Type:Organization
Organization Name:JOHN'E JASPER EPPS, DDS, PLC
Other - Org Name:HEAVENLY HANDS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN'E
Authorized Official - Middle Name:JASPER
Authorized Official - Last Name:EPPS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-304-9670
Mailing Address - Street 1:19710 SIOUX LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23805-8830
Mailing Address - Country:US
Mailing Address - Phone:804-304-9670
Mailing Address - Fax:
Practice Address - Street 1:9460 AMBERDALE DR
Practice Address - Street 2:SUITE H
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-1259
Practice Address - Country:US
Practice Address - Phone:804-304-9670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014143271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905431Medicaid