Provider Demographics
NPI:1861647422
Name:FREDERIC V HEPP, DDS, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:FREDERIC V HEPP, DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-569-1795
Mailing Address - Street 1:1805 STATE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-8415
Mailing Address - Country:US
Mailing Address - Phone:805-569-1795
Mailing Address - Fax:805-569-1469
Practice Address - Street 1:1805 STATE ST
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-8415
Practice Address - Country:US
Practice Address - Phone:805-569-1795
Practice Address - Fax:805-569-1469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA399641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty