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General NPI Number Information
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NPI Number | 1104013937
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Entity Type | Individual
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Provider Name | MICHAEL CALVIN JEPPSON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 09/25/2007
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Provider Practice Location Address
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Address Line | 1224 S RIVER RD BLDG D
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City | SAINT GEORGE
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State | UT
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Zip | 84790-8285
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Country | US
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Telephone | 435-628-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 2445 E 2860 S
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City | SAINT GEORGE
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State | UT
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Zip | 84790-4707
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Country | US
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Telephone | 801-518-4998
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5262668-9923
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License Number State | UT
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