Provider Demographics
NPI:1659724805
Name:JARED J PELL DDS PC
Entity Type:Organization
Organization Name:JARED J PELL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:J
Authorized Official - Last Name:PELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-667-8731
Mailing Address - Street 1:1705 AMHERST ST
Mailing Address - Street 2:STE 102
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3346
Mailing Address - Country:US
Mailing Address - Phone:540-667-8731
Mailing Address - Fax:540-662-5072
Practice Address - Street 1:1705 AMHERST ST
Practice Address - Street 2:STE 102
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3346
Practice Address - Country:US
Practice Address - Phone:540-667-8731
Practice Address - Fax:540-662-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty