Provider Demographics
NPI:1124020920
Name:JARED R. ANDERSON DDS PC
Entity Type:Organization
Organization Name:JARED R. ANDERSON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-923-7633
Mailing Address - Street 1:774 SW RIMROCK DR
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1941
Mailing Address - Country:US
Mailing Address - Phone:541-923-7633
Mailing Address - Fax:541-923-8733
Practice Address - Street 1:774 SW RIMROCK DR
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1941
Practice Address - Country:US
Practice Address - Phone:541-923-7633
Practice Address - Fax:541-923-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6510C1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty