Provider Demographics
NPI:1720249931
Name:MARTIN, JARED S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:S
Last Name:MARTIN
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 1:15506 CHESDIN LANDING PL
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-3238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4722 N SOUTHSIDE PLAZA ST
Practice Address - Street 2:#24
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-1742
Practice Address - Country:US
Practice Address - Phone:804-319-5665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014124831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice