Provider Demographics
NPI:1336646520
Name:URE, JARED (DMD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:URE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ALABAMA ST STE A
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-2518
Mailing Address - Country:US
Mailing Address - Phone:850-682-4516
Mailing Address - Fax:
Practice Address - Street 1:102 ALABAMA ST STE A
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-2518
Practice Address - Country:US
Practice Address - Phone:850-682-4516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL266001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice