Provider Demographics
NPI:1972831709
Name:JEPPSEN, PETER NEILSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:NEILSON
Last Name:JEPPSEN
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 1:2814 RIDGE VIEW CIRCLE
Mailing Address - Street 2:APT D
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516
Mailing Address - Country:US
Mailing Address - Phone:918-207-5526
Mailing Address - Fax:
Practice Address - Street 1:2500 30TH ST STE 204
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1258
Practice Address - Country:US
Practice Address - Phone:918-207-5526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3717122300000X
CODEN.002031871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist