Provider Demographics
NPI:1346227618
Name:JEPSEN, SHAWN ARNELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ARNELL
Last Name:JEPSEN
Suffix:
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:US ARMY DENTAL ACTIVITY BLDG 9900
Mailing Address - Street 2:2ND FL , CREDENTIALS OFFICE, ATTN: PEGGY LEWIS
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431
Mailing Address - Country:US
Mailing Address - Phone:253-968-4039
Mailing Address - Fax:253-968-4039
Practice Address - Street 1:US ARMY DENTAL ACTIVITY BLDG 9900
Practice Address - Street 2:2ND FL , CREDENTIALS OFFICE, ATTN: PEGGY LEWIS
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431
Practice Address - Country:US
Practice Address - Phone:253-968-4039
Practice Address - Fax:253-968-4039
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist