Provider Demographics
NPI:1265532451
Name:YEPES, JUAN F (DDS, MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:F
Last Name:YEPES
Suffix:
Gender:M
Credentials:DDS, MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 RILEY HOSPITAL DR RM 4205
Mailing Address - Street 2:DEPARTMENT OF PEDIATRIC DENTISTRY
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5109
Mailing Address - Country:US
Mailing Address - Phone:317-944-9601
Mailing Address - Fax:
Practice Address - Street 1:705 RILEY HOSPITAL DR RM 4205
Practice Address - Street 2:DEPARTMENT OF PEDIATRIC DENTISTRY
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-9601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012166A1223P0221X
KY81661223X0008X, 1223P0221X
KYFL034208D00000X
MND123221223P0221X
NY0578651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60003191Medicaid
KY60003191Medicaid
KYV03764Medicare UPIN