Healthcare Provider Details

I. General information

NPI: 1316665383
Provider Name (Legal Business Name): JARED HYER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 W FLAMINGO RD
LAS VEGAS NV
89103-3704
US

IV. Provider business mailing address

808 WINDHOOK ST
LAS VEGAS NV
89144-1354
US

V. Phone/Fax

Practice location:
  • Phone: 702-687-7000
  • Fax:
Mailing address:
  • Phone: 702-373-7977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7678
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: