Healthcare Provider Details

I. General information

NPI: 1497981104
Provider Name (Legal Business Name): JARED CAMERON BECK D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 WOOD RD
BETHESDA MD
20889-5750
US

IV. Provider business mailing address

6266 COBBLECREST RD
HOLLADAY UT
84121-2218
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-1614
  • Fax:
Mailing address:
  • Phone: 801-274-0599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3105693-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: