Provider Demographics
NPI:1376812933
Name:JARED R BROWN DMD MS PC
Entity Type:Organization
Organization Name:JARED R BROWN DMD MS PC
Other - Org Name:WASATCH ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:REED
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:435-654-4586
Mailing Address - Street 1:380 E 1500 S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3940
Mailing Address - Country:US
Mailing Address - Phone:435-654-4586
Mailing Address - Fax:
Practice Address - Street 1:380 E 1500 S
Practice Address - Street 2:SUITE 200
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3940
Practice Address - Country:US
Practice Address - Phone:435-654-4586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT616228399211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty