Provider Demographics
NPI:1336580414
Name:FUNT, JARED ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:ALAN
Last Name:FUNT
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 1:100 BELLEMEADE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3530
Mailing Address - Country:US
Mailing Address - Phone:631-675-1694
Mailing Address - Fax:
Practice Address - Street 1:100 BELLEMEADE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3530
Practice Address - Country:US
Practice Address - Phone:631-675-1694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055786-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics