Provider Demographics
NPI:1972033496
Name:ROBERTS, JARED EMERSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:EMERSON
Last Name:ROBERTS
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 1:9692 LEVIN RD NW STE 202
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7801
Mailing Address - Country:US
Mailing Address - Phone:360-698-2323
Mailing Address - Fax:
Practice Address - Street 1:9692 LEVIN RD NW STE 202
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7801
Practice Address - Country:US
Practice Address - Phone:360-698-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE607567181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry