Provider Demographics
NPI:1700051760
Name:DOMAN, JARED (DMD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:DOMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 TRIANGLE SHOPPING CTR STE 660
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 TRIANGLE SHOPPING CTR STE 660
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4690
Practice Address - Country:US
Practice Address - Phone:360-803-8003
Practice Address - Fax:360-283-0864
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00011054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist