Healthcare Provider Details

I. General information

NPI: 1619436425
Provider Name (Legal Business Name): JASON ANDREW TEPPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 E SPANISH FORK PKWY STE 101
SPANISH FORK UT
84660-1496
US

IV. Provider business mailing address

2191 S MCCLELLAND ST APT 548
SALT LAKE CITY UT
84106-4455
US

V. Phone/Fax

Practice location:
  • Phone: 801-798-9500
  • Fax:
Mailing address:
  • Phone: 385-831-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number13788895-9924
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD14380
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number13788895-9924
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: