Healthcare Provider Details

I. General information

NPI: 1912322389
Provider Name (Legal Business Name): FREDERIC VIRGIL HEPP DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 STATE ST SUITE C
SANTA BARBARA CA
93101-8415
US

IV. Provider business mailing address

1805 STATE ST SUITE C
SANTA BARBARA CA
93101-8415
US

V. Phone/Fax

Practice location:
  • Phone: 805-569-1795
  • Fax: 805-569-1469
Mailing address:
  • Phone: 805-569-1795
  • Fax: 805-569-1469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: