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General NPI Number Information
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NPI Number | 1073947958
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Entity Type | Organization
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Legal Business Name | JEPPSON ENDODONTICS, PLLC
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Dates
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Enumeration Date | 08/27/2013
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 101 E MAIN ST SUITE 202
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City | REXBURG
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State | ID
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Zip | 83440-2000
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Country | US
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Telephone | 208-357-4826
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E MAIN ST SUITE 202
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City | REXBURG
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State | ID
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Zip | 83440-2000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSHUA JEPPSON
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Credential | DDS
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Telephone | 208-357-4826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 8121225-9921
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 8121225-9922
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D-4167-EN
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License Number State | ID
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