Provider Demographics
NPI:1912322389
Name:HEPP, FREDERIC VIRGIL (DDS)
Entity type:Individual
Prefix:
First Name:FREDERIC
Middle Name:VIRGIL
Last Name:HEPP
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 1:1805 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
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA399641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice