Provider Demographics
NPI:1417157355
Name:RASMUSSEN, JARED E (DMD, MD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:E
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 E COMMERCE DR # DRIVE203
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-4022
Mailing Address - Country:US
Mailing Address - Phone:801-786-3200
Mailing Address - Fax:801-766-1121
Practice Address - Street 1:76 E COMMERCE DR # DRIVE203
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-4022
Practice Address - Country:US
Practice Address - Phone:801-786-3200
Practice Address - Fax:801-766-1121
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8598613-99241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery