Healthcare Provider Details

I. General information

NPI: 1821934100
Provider Name (Legal Business Name): JARED JAMES NEVILLE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 CHRISTY DR
JEFFERSON CITY MO
65101-2854
US

IV. Provider business mailing address

5 DONNA RD UNIT B
WINDHAM ME
04062-6120
US

V. Phone/Fax

Practice location:
  • Phone: 573-632-2777
  • Fax:
Mailing address:
  • Phone: 208-243-3942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: