Healthcare Provider Details

I. General information

NPI: 1437881331
Provider Name (Legal Business Name): SEAN BLAIR JEPPESEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 CHAMBLESS LN
HAMILTON GA
31811-6144
US

IV. Provider business mailing address

222 CHAMBLESS LN
HAMILTON GA
31811-6144
US

V. Phone/Fax

Practice location:
  • Phone: 706-641-0432
  • Fax:
Mailing address:
  • Phone: 706-641-0432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN122690
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: