Provider Demographics
NPI:1578903670
Name:TRAVELLER, JARON (DDS)
Entity Type:Individual
Prefix:
First Name:JARON
Middle Name:
Last Name:TRAVELLER
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 1:1913 W 500 S
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-2894
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7430 S CREEK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6158
Practice Address - Country:US
Practice Address - Phone:801-561-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6134075-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice