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General NPI Number Information
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NPI Number | 1972624880
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Entity Type | Individual
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Provider Name | KYLE D JEPSEN DMD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 208 N MARKET ST 322
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City | DALLAS
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State | TX
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Zip | 75202-3206
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Country | US
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Telephone | 214-757-4500
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Fax | 214-757-4501
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Provider Business Mailing Address
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Address Line | 13525 SPRUCEWOOD DR
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City | DALLAS
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State | TX
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Zip | 75240-3630
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Country | US
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Telephone | 214-629-6153
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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 | 22833
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 13569
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN.00205860
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22833
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License Number State | TX
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