Provider Demographics
NPI:1083141055
Name:RICHARD, JARED MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:MICHAEL
Last Name:RICHARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 UNION DEPOSIT RD STE 210
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3774
Mailing Address - Country:US
Mailing Address - Phone:717-545-2003
Mailing Address - Fax:
Practice Address - Street 1:4700 UNION DEPOSIT RD STE 210
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-3774
Practice Address - Country:US
Practice Address - Phone:717-510-1309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0416481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice