Provider Demographics
NPI:1356473391
Name:JOHN W EPPERSON, D.D.S., P.A.
Entity Type:Organization
Organization Name:JOHN W EPPERSON, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:EPPERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-745-1745
Mailing Address - Street 1:8220 MEMPHIS AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:806-771-1795
Practice Address - Street 1:8220 MEMPHIS AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2612
Practice Address - Country:US
Practice Address - Phone:806-745-1745
Practice Address - Fax:806-771-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty