Provider Demographics
NPI:1699177048
Name:JEPSON, DOUGLAS TRENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:TRENT
Last Name:JEPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 SAINT JOHN PLACE
Mailing Address - Street 2:SUITE C
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543
Mailing Address - Country:US
Mailing Address - Phone:951-652-4040
Mailing Address - Fax:951-652-4051
Practice Address - Street 1:810 SAINT JOHN PLACE
Practice Address - Street 2:SUITE C
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543
Practice Address - Country:US
Practice Address - Phone:951-652-4040
Practice Address - Fax:951-652-4051
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist