MEDICARE: JASON TEERLINK DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8033235-9922	UT

General Provider Information

NPI Number	:	1235426396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON TEERLINK DMD

Provider Business Mailing Address
First Line	:	5633 W 6200 S STE A6
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84118-7920
Country	:	US
Telephone Number	:	801-955-1112
Fax Number	:	801-963-4736

Provider Business Practice Location Address
First Line	:	5633 W 6200 S STE A6
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84118-7920
Country	:	US
Telephone Number	:	801-955-1112
Fax Number	:	801-963-4736

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	02/12/2013

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