Healthcare Provider Details

I. General information

NPI: 1104013937
Provider Name (Legal Business Name): MICHAEL CALVIN JEPPSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 S RIVER RD BLDG D
SAINT GEORGE UT
84790-8285
US

IV. Provider business mailing address

2445 E 2860 S
SAINT GEORGE UT
84790-4707
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-9600
  • Fax:
Mailing address:
  • Phone: 801-518-4998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5262668-9923
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: