Healthcare Provider Details

I. General information

NPI: 1992279384
Provider Name (Legal Business Name): JARED SMITH, PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 COUNTY ROAD 68
BAILEY CO
80421
US

IV. Provider business mailing address

16241 BLUEBONNET DR
PARKER CO
80134-3540
US

V. Phone/Fax

Practice location:
  • Phone: 303-838-2224
  • Fax:
Mailing address:
  • Phone: 801-979-9342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JARED SPENCER SMITH
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 801-979-9342