Healthcare Provider Details

I. General information

NPI: 1124164785
Provider Name (Legal Business Name): ROBERT MARION JARRETT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S MERAMEC AVE
CLAYTON MO
63105-1711
US

IV. Provider business mailing address

1360 HAUTE LOIRE DR
MANCHESTER MO
63011-2964
US

V. Phone/Fax

Practice location:
  • Phone: 314-615-8153
  • Fax:
Mailing address:
  • Phone: 636-394-4642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number011045
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: