Provider Demographics
NPI:1003961871
Name:KRIEGER, JARED T (DMD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:T
Last Name:KRIEGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 TADSWORTH TER
Mailing Address - Street 2:
Mailing Address - City:HEATHROW
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5333
Mailing Address - Country:US
Mailing Address - Phone:407-333-4644
Mailing Address - Fax:
Practice Address - Street 1:707 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 1200
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6471
Practice Address - Country:US
Practice Address - Phone:407-478-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN127341223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics