Healthcare Provider Details

I. General information

NPI: 1063301448
Provider Name (Legal Business Name): JARED ANDREW INING DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 N MCDOWELL BLVD
PETALUMA CA
94954-6559
US

IV. Provider business mailing address

4028 24TH ST
SAN FRANCISCO CA
94114-3716
US

V. Phone/Fax

Practice location:
  • Phone: 707-559-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: