Provider Demographics
NPI:1316208481
Name:JARED POPE DDS PLC
Entity Type:Organization
Organization Name:JARED POPE DDS PLC
Other - Org Name:PROGRESSIVE DENTISTRY & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:M
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-332-6111
Mailing Address - Street 1:2995 W ELLIOT RD
Mailing Address - Street 2:STE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1670
Mailing Address - Country:US
Mailing Address - Phone:480-775-8600
Mailing Address - Fax:480-775-0240
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:85138-2903
Practice Address - Country:US
Practice Address - Phone:520-568-9100
Practice Address - Fax:520-568-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty