Provider Demographics
NPI:1568896264
Name:JARED, GEORGE CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:CHRISTOPHER
Last Name:JARED
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 1:13465 CAMINO CANADA
Mailing Address - Street 2:STE. 110A
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-8813
Mailing Address - Country:US
Mailing Address - Phone:619-390-3669
Mailing Address - Fax:619-390-3328
Practice Address - Street 1:13465 CAMINO CANADA
Practice Address - Street 2:STE. 110A
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-8813
Practice Address - Country:US
Practice Address - Phone:619-390-3669
Practice Address - Fax:619-390-3328
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist