Provider Demographics
NPI:1932558624
Name:GITTLEMAN, JARED (DMD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:GITTLEMAN
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 1:1319 LINCOLN AVE PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19076-1216
Mailing Address - Country:US
Mailing Address - Phone:610-532-5008
Mailing Address - Fax:
Practice Address - Street 1:1319 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:PA
Practice Address - Zip Code:19076-1216
Practice Address - Country:US
Practice Address - Phone:610-532-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040782122300000X
NJ22DI02643000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist