Provider Demographics
NPI:1013115344
Name:WEST, JERAD L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERAD
Middle Name:L
Last Name:WEST
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 1:10021 MARTIS VALLEY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-2125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10021 MARTIS VALLEY RD
Practice Address - Street 2:SUITE B
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-2125
Practice Address - Country:US
Practice Address - Phone:530-587-5582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics