Provider Demographics
NPI:1750505194
Name:SEPE, JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:SEPE
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 1:12775 GATE DR
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-5870
Mailing Address - Country:US
Mailing Address - Phone:858-705-0406
Mailing Address - Fax:858-513-1113
Practice Address - Street 1:15835 POMERADO RD STE 203
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2042
Practice Address - Country:US
Practice Address - Phone:858-485-8012
Practice Address - Fax:858-485-5615
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA350251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice