Provider Demographics
NPI:1003202060
Name:JARED POPLIN D.M.D., PLLC
Entity Type:Organization
Organization Name:JARED POPLIN D.M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:POPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:785-691-6171
Mailing Address - Street 1:6850 AUSTIN CENTER BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6850 AUSTIN CENTER BLVD STE 220
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3131
Practice Address - Country:US
Practice Address - Phone:785-691-6171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211924002Medicaid
TX211924001Medicaid
TX211924003Medicaid