Provider Demographics
NPI:1366002891
Name:JEPSEN, JESSIE PRICE (DMD)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:PRICE
Last Name:JEPSEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:ERIN
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:842 VERNON RD
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2465
Mailing Address - Country:US
Mailing Address - Phone:903-826-4318
Mailing Address - Fax:
Practice Address - Street 1:1412 N COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1005
Practice Address - Country:US
Practice Address - Phone:903-826-4318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.027097122300000X
390200000X
PADS042558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program