Provider Demographics
NPI:1356850069
Name:JARED C. CONDIE DMD & BRIAN L. TUFT DMD LLC
Entity Type:Organization
Organization Name:JARED C. CONDIE DMD & BRIAN L. TUFT DMD LLC
Other - Org Name:CONDIE & TUFT FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUFT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-489-7364
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-0190
Mailing Address - Country:US
Mailing Address - Phone:801-489-7364
Mailing Address - Fax:801-491-8629
Practice Address - Street 1:485 S MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2291
Practice Address - Country:US
Practice Address - Phone:801-489-7364
Practice Address - Fax:801-491-8629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT66542641223G0001X
UT1457701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty