Healthcare Provider Details

I. General information

NPI: 1790827277
Provider Name (Legal Business Name): J PHILIP EPLING III A PROFESSIONAL DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63222 HIGHWAY 1090
PEARL RIVER LA
70452
US

IV. Provider business mailing address

63222 HIGHWAY 1090
PEARL RIVER LA
70452
US

V. Phone/Fax

Practice location:
  • Phone: 985-863-7687
  • Fax: 985-863-7027
Mailing address:
  • Phone: 985-863-7687
  • Fax: 985-863-7027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4069
License Number StateLA

VIII. Authorized Official

Name: JOHN PHILIP EPLING III
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 985-863-7687