Healthcare Provider Details

I. General information

NPI: 1558530097
Provider Name (Legal Business Name): JOHN C JEPPESEN DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 10/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 S VICTORIA AVE SUITE C & D
VENTURA CA
93003-4329
US

IV. Provider business mailing address

178 S VICTORIA AVE SUITE C & D
VENTURA CA
93003-4329
US

V. Phone/Fax

Practice location:
  • Phone: 805-644-2270
  • Fax: 805-644-2576
Mailing address:
  • Phone: 805-644-2270
  • Fax: 805-644-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. BRENDA JEPPESEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 805-644-2270