Provider Demographics
NPI:1174639413
Name:DAVID P JARRELL DDS INC
Entity Type:Organization
Organization Name:DAVID P JARRELL DDS INC
Other - Org Name:JARRELL ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:765-453-4261
Mailing Address - Street 1:314 E ALTO RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902
Mailing Address - Country:US
Mailing Address - Phone:765-453-4261
Mailing Address - Fax:765-453-4829
Practice Address - Street 1:314 E ALTO RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902
Practice Address - Country:US
Practice Address - Phone:765-453-4261
Practice Address - Fax:765-453-4829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009911A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty