Healthcare Provider Details

I. General information

NPI: 1366002891
Provider Name (Legal Business Name): JESSIE PRICE JEPSEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSIE ERIN PRICE DMD

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 01/21/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 N COURT ST
CIRCLEVILLE OH
43113-1005
US

IV. Provider business mailing address

842 VERNON RD
BEXLEY OH
43209-2465
US

V. Phone/Fax

Practice location:
  • Phone: 903-826-4318
  • Fax:
Mailing address:
  • Phone: 903-826-4318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.027097
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS042558
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: