Provider Demographics
NPI:1801655964
Name:JARDINE ALLIANCE PLLC
Entity type:Organization
Organization Name:JARDINE ALLIANCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:JARDINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-368-8674
Mailing Address - Street 1:784 W 2920 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6022
Mailing Address - Country:US
Mailing Address - Phone:801-368-8674
Mailing Address - Fax:
Practice Address - Street 1:3330 N UNIVERSITY AVE STE A
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4454
Practice Address - Country:US
Practice Address - Phone:801-615-2917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental