=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760647572
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEPSEN & ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2008
-----------------------------------------------------
Last Update Date | 07/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11411 PEARL ST
-----------------------------------------------------
City | NORTHGLENN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80233-1965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-452-4556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11411 N PEARL STREET
-----------------------------------------------------
City | NORTHGLENN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-452-4556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. NEAL HENRY JEPSEN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 303-452-4556
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 104288
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------