Healthcare Provider Details

I. General information

NPI: 1306164108
Provider Name (Legal Business Name): JEPPESEN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

VIII. Authorized Official

Name: DR. JOHN JEPPESEN
Title or Position: PRESIDENT
Credential: DMD
Phone: 805-644-2270