Provider Demographics
NPI:1831335199
Name:JEPPSON, JOSEPH CHARLES (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CHARLES
Last Name:JEPPSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 N UNIVERSITY AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-5658
Mailing Address - Country:US
Mailing Address - Phone:801-356-7701
Mailing Address - Fax:801-356-1877
Practice Address - Street 1:86 N UNIVERSITY AVE STE 280
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-5658
Practice Address - Country:US
Practice Address - Phone:801-356-7701
Practice Address - Fax:801-356-1877
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT294692-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1497850309OtherNPI TYPE 2