Provider Demographics
NPI:1760992382
Name:JARED R. ANDERSON, DDS, PC
Entity Type:Organization
Organization Name:JARED R. ANDERSON, DDS, PC
Other - Org Name:SELECT CARE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-323-3930
Mailing Address - Street 1:499 SW UPPER TERRACE DR. #B
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702
Mailing Address - Country:US
Mailing Address - Phone:541-323-3930
Mailing Address - Fax:541-323-3929
Practice Address - Street 1:499 SW UPPER TERRACE DR. #B
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:541-323-3930
Practice Address - Fax:541-323-3929
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JARED R. ANDERSON, DDS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8086122300000X
ORD10730122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty