MEDICARE: JOHN'E JASPER EPPS, DDS, PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401414327	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285035444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN'E JASPER EPPS, DDS, PLC

Provider Business Mailing Address
First Line	:	19710 SIOUX LN
Second Line	:
City	:	SOUTH PRINCE GEORGE
State	:	VA
Zip	:	23805-8830
Country	:	US
Telephone Number	:	804-304-9670
Fax Number	:

Provider Business Practice Location Address
First Line	:	9460 AMBERDALE DR
Second Line	:	SUITE H
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-1259
Country	:	US
Telephone Number	:	804-304-9670
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN'E JASPER EPPS
Credential	:	DDS
Telephone Number	:	804-304-9670

Provider Enumeration Date	:	09/08/2014
Last Update Date	:	09/08/2014

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