Provider Demographics
NPI:1013924117
Name:JARED M FURGESON DDS PLLC
Entity Type:Organization
Organization Name:JARED M FURGESON DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:FURGESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-887-9000
Mailing Address - Street 1:2700 W CHERRY LN
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1137
Mailing Address - Country:US
Mailing Address - Phone:208-887-9000
Mailing Address - Fax:
Practice Address - Street 1:2700 W CHERRY LN
Practice Address - Street 2:SUITE 120
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1137
Practice Address - Country:US
Practice Address - Phone:208-887-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-3800261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID=========OtherTID