Provider Demographics
NPI:1366880213
Name:KEPLER, JESSICA M (DDS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:KEPLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-3601
Mailing Address - Country:US
Mailing Address - Phone:913-287-7977
Mailing Address - Fax:913-287-5022
Practice Address - Street 1:4655 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-3603
Practice Address - Country:US
Practice Address - Phone:913-287-7977
Practice Address - Fax:913-287-5022
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS609901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1366880213Medicaid
KS2891559OtherUNITED CONCORDIA
KS201072700CMedicaid