Healthcare Provider Details

I. General information

NPI: 1831335199
Provider Name (Legal Business Name): JOSEPH CHARLES JEPPSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 N UNIVERSITY AVE STE 280
PROVO UT
84601-5658
US

IV. Provider business mailing address

86 N UNIVERSITY AVE STE 280
PROVO UT
84601-5658
US

V. Phone/Fax

Practice location:
  • Phone: 801-356-7701
  • Fax: 801-356-1877
Mailing address:
  • Phone: 801-356-7701
  • Fax: 801-356-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number294692-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: