Provider Demographics
NPI:1790827277
Name:J PHILIP EPLING III A PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:J PHILIP EPLING III A PROFESSIONAL DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:EPLING
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-863-7687
Mailing Address - Street 1:63222 HIGHWAY 1090
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452
Mailing Address - Country:US
Mailing Address - Phone:985-863-7687
Mailing Address - Fax:985-863-7027
Practice Address - Street 1:63222 HIGHWAY 1090
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:LA
Practice Address - Zip Code:70452
Practice Address - Country:US
Practice Address - Phone:985-863-7687
Practice Address - Fax:985-863-7027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4069122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty