Healthcare Provider Details

I. General information

NPI: 1962285502
Provider Name (Legal Business Name): EPLETT AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 BENNETT AVE
MEDFORD OR
97504-6722
US

IV. Provider business mailing address

720 BENNETT AVE
MEDFORD OR
97504-6722
US

V. Phone/Fax

Practice location:
  • Phone: 458-215-5806
  • Fax:
Mailing address:
  • Phone: 458-215-5806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALISHA EPLETT
Title or Position: CEO
Credential: DL
Phone: 458-215-5806