MEDICARE: DR. JARED GLEN CURTIS 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	1223G0001X	General Practice Dentistry	DE 60384641	WA
2	1223G0001X	General Practice Dentistry	D4540	ID
3	1223G0001X	General Practice Dentistry	9094625-9922	UT

General Provider Information

NPI Number	:	1346688520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JARED GLEN CURTIS DMD

Provider Business Mailing Address
First Line	:	4775 W DAYBREAK PKWY
Second Line	:	SUITE 201
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-5138
Country	:	US
Telephone Number	:	801-280-1911
Fax Number	:	801-255-2394

Provider Business Practice Location Address
First Line	:	4775 W DAYBREAK PKWY
Second Line	:	SUITE 201
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-5138
Country	:	US
Telephone Number	:	801-280-1911
Fax Number	:	801-255-2394

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

Provider Enumeration Date	:	06/10/2013
Last Update Date	:	09/09/2014

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