Provider Demographics
NPI:1467431114
Name:JARROLD, GARY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LYNN
Last Name:JARROLD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 BEULAH HWY
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:MI
Mailing Address - Zip Code:49617-9701
Mailing Address - Country:US
Mailing Address - Phone:231-882-4424
Mailing Address - Fax:231-882-4450
Practice Address - Street 1:589 BEULAH HWY
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:MI
Practice Address - Zip Code:49617-9701
Practice Address - Country:US
Practice Address - Phone:231-882-4424
Practice Address - Fax:231-882-4450
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI011971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice