Provider Demographics
NPI:1013924208
Name:FURGESON, JARED
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:FURGESON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:208-887-9107
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:208-887-9107
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-38001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID203915255OtherTID