Individual
JEFFERY K. RUPP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.S.
Contact information
Practice address
1548 E 4500 S, SUITE 102, SALT LAKE CITY, UT 84117-4209
(801) 463-1900
Mailing address
1548 E 4500 S, SUITE 102, SALT LAKE CITY, UT 84117-4209
(801) 463-1900
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
6273877-9922
UT
Other
Enumeration date
12/13/2006
Last updated
09/27/2012
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