Healthcare Provider Details

I. General information

NPI: 1760647572
Provider Name (Legal Business Name): JEPSEN & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11411 PEARL ST
NORTHGLENN CO
80233-1965
US

IV. Provider business mailing address

11411 N PEARL STREET
NORTHGLENN CO
80233
US

V. Phone/Fax

Practice location:
  • Phone: 303-452-4556
  • Fax:
Mailing address:
  • Phone: 303-452-4556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number104288
License Number StateCO

VIII. Authorized Official

Name: DR. NEAL HENRY JEPSEN
Title or Position: PRESIDENT
Credential: DDS
Phone: 303-452-4556