Provider Demographics
NPI:1770334096
Name:FAUSNAUGHT, JARED KIRBY (DMD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:KIRBY
Last Name:FAUSNAUGHT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1496 W STONE GATE DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-5358
Mailing Address - Country:US
Mailing Address - Phone:801-717-6505
Mailing Address - Fax:
Practice Address - Street 1:10894 S RIVER FRONT PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5609
Practice Address - Country:US
Practice Address - Phone:801-878-1251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program