Provider Demographics
NPI:1134340698
Name:JESPERSON, JARED CRAIG (DDS)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:CRAIG
Last Name:JESPERSON
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 1:1140 BRICKYARD RD
Mailing Address - Street 2:#32B
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2565
Mailing Address - Country:US
Mailing Address - Phone:801-474-9552
Mailing Address - Fax:801-474-9558
Practice Address - Street 1:1140 BRICKYARD RD
Practice Address - Street 2:#32B
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2565
Practice Address - Country:US
Practice Address - Phone:801-474-9552
Practice Address - Fax:801-474-9558
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5451902-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice