Provider Demographics
NPI:1851368310
Name:JEPSEN, NEAL HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:HENRY
Last Name:JEPSEN
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 1:11411 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1965
Mailing Address - Country:US
Mailing Address - Phone:303-452-4556
Mailing Address - Fax:303-280-3693
Practice Address - Street 1:11411 PEARL ST
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-1965
Practice Address - Country:US
Practice Address - Phone:303-452-4556
Practice Address - Fax:303-280-3693
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1042881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice