Provider Demographics
NPI:1265753453
Name:HARDING, JARED JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:JOHN
Last Name:HARDING
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:N4380 BEAUDIN LN
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-9005
Mailing Address - Country:US
Mailing Address - Phone:608-886-0223
Mailing Address - Fax:
Practice Address - Street 1:105 KELLY WAY
Practice Address - Street 2:
Practice Address - City:HORTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54944-8755
Practice Address - Country:US
Practice Address - Phone:608-886-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6537-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice