Provider Demographics
NPI:1437316080
Name:JARRELL FAMILY DENTISTRY
Entity Type:Organization
Organization Name:JARRELL FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:S
Authorized Official - Last Name:JARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-934-6269
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:SURVEYOR
Mailing Address - State:WV
Mailing Address - Zip Code:25932-0290
Mailing Address - Country:US
Mailing Address - Phone:304-934-6269
Mailing Address - Fax:304-934-6223
Practice Address - Street 1:6463 HARPER ROAD
Practice Address - Street 2:
Practice Address - City:SURVEYOR
Practice Address - State:WV
Practice Address - Zip Code:25932
Practice Address - Country:US
Practice Address - Phone:304-934-6269
Practice Address - Fax:304-934-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009412Medicaid