Healthcare Provider Details

I. General information

NPI: 1962597120
Provider Name (Legal Business Name): JOHN PHILIP EPLING III D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63222 HIGHWAY 1090
PEARL RIVER LA
70452-4136
US

IV. Provider business mailing address

63222 HIGHWAY 1090
PEARL RIVER LA
70452-4136
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 Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberLA 4069
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: