Provider Demographics
NPI:1790960862
Name:JAMIE B. EPPERSON, DDS, PA
Entity Type:Organization
Organization Name:JAMIE B. EPPERSON, DDS, PA
Other - Org Name:TWELVE OAKS DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:EPPERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-549-2183
Mailing Address - Street 1:401 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-2521
Mailing Address - Country:US
Mailing Address - Phone:940-549-2183
Mailing Address - Fax:940-549-4215
Practice Address - Street 1:401 OAK ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-2521
Practice Address - Country:US
Practice Address - Phone:940-549-2183
Practice Address - Fax:940-549-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K28QOtherBCBS
TX970005OtherUCCI