Provider Demographics
NPI:1295946291
Name:PELL, JARED J (DDS)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:J
Last Name:PELL
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 1:1705 AMHERST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3346
Mailing Address - Country:US
Mailing Address - Phone:540-667-8731
Mailing Address - Fax:540-662-5072
Practice Address - Street 1:1705 AMHERST ST STE 102
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3346
Practice Address - Country:US
Practice Address - Phone:540-667-8731
Practice Address - Fax:540-662-5072
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410209122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist