Healthcare Provider Details

I. General information

NPI: 1386047231
Provider Name (Legal Business Name): KRISTEN ANN JEPSON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S.W. BELAIR DRIVE
CLATSKANIE OR
97016
US

IV. Provider business mailing address

P.O. BOX 749
CLATSKANIE OR
97016
US

V. Phone/Fax

Practice location:
  • Phone: 503-728-2114
  • Fax: 503-728-3322
Mailing address:
  • Phone: 503-728-2114
  • Fax: 503-728-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH5042
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: