Healthcare Provider Details

I. General information

NPI: 1073595955
Provider Name (Legal Business Name): JAMES ALAN JESPERSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 21ST AVE
ROCK VALLEY IA
51247-1420
US

IV. Provider business mailing address

2150 325TH ST
ROCK VALLEY IA
51247-7580
US

V. Phone/Fax

Practice location:
  • Phone: 712-476-2749
  • Fax:
Mailing address:
  • Phone: 712-476-5830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number05966
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: