Healthcare Provider Details

I. General information

NPI: 1902829542
Provider Name (Legal Business Name): JEFFREY W. TEPPER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 NEW BRITAIN AVE
UNIONVILLE CT
06085-1277
US

IV. Provider business mailing address

15 NEW BRITAIN AVE
UNIONVILLE CT
06085-1277
US

V. Phone/Fax

Practice location:
  • Phone: 860-673-2455
  • Fax: 860-675-8019
Mailing address:
  • Phone: 860-673-2455
  • Fax: 860-675-8019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5949
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: