Provider Demographics
NPI:1275667479
Name:POPE, JARED MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:MICHAEL
Last Name:POPE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JARED
Other - Middle Name:POPE
Other - Last Name:DDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:44480 W HONEYCUTT RD
Mailing Address - Street 2:STE 110
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138
Mailing Address - Country:US
Mailing Address - Phone:520-568-9100
Mailing Address - Fax:520-568-9190
Practice Address - Street 1:44480 W HONEYCUTT RD
Practice Address - Street 2:STE 110
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138
Practice Address - Country:US
Practice Address - Phone:520-568-9100
Practice Address - Fax:520-568-9190
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD56251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ72-1527580OtherTAX ID#
AZ1399646OtherUNITED CONCORDIA