Healthcare Provider Details

I. General information

NPI: 1336646520
Provider Name (Legal Business Name): JARED URE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 ALABAMA ST STE A
CRESTVIEW FL
32536-2518
US

IV. Provider business mailing address

102 ALABAMA ST STE A
CRESTVIEW FL
32536-2518
US

V. Phone/Fax

Practice location:
  • Phone: 850-682-4516
  • Fax:
Mailing address:
  • Phone: 850-682-4516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number26600
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: