Provider Demographics
NPI:1659409134
Name:WILLIAMS, JARED BOWMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:BOWMAN
Last Name:WILLIAMS
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 1:855 E BROWN RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-4958
Mailing Address - Country:US
Mailing Address - Phone:480-962-1561
Mailing Address - Fax:
Practice Address - Street 1:855 E BROWN RD
Practice Address - Street 2:SUITE 3
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-4958
Practice Address - Country:US
Practice Address - Phone:480-962-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist