Provider Demographics
NPI:1346720299
Name:JARRETT, DILLON TREY
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:TREY
Last Name:JARRETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 SHALIMAR DR
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-4952
Mailing Address - Country:US
Mailing Address - Phone:504-410-4929
Mailing Address - Fax:
Practice Address - Street 1:1413 SHALIMAR DR
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-4952
Practice Address - Country:US
Practice Address - Phone:504-410-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist