Provider Demographics
NPI:1437881331
Name:JEPPESEN, SEAN BLAIR (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:BLAIR
Last Name:JEPPESEN
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 1:222 CHAMBLESS LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:GA
Mailing Address - Zip Code:31811-6144
Mailing Address - Country:US
Mailing Address - Phone:706-641-0432
Mailing Address - Fax:
Practice Address - Street 1:222 CHAMBLESS LN
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:GA
Practice Address - Zip Code:31811-6144
Practice Address - Country:US
Practice Address - Phone:706-641-0432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122690122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN122690OtherDENTAL LICENSE NUMBER