Healthcare Provider Details

I. General information

NPI: 1154058642
Provider Name (Legal Business Name): JARRED DEWBRE DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 E 33RD ST
EDMOND OK
73013-4602
US

IV. Provider business mailing address

169 E 33RD ST
EDMOND OK
73013-4602
US

V. Phone/Fax

Practice location:
  • Phone: 405-341-5030
  • Fax: 405-471-6550
Mailing address:
  • Phone: 877-667-7669
  • Fax: 888-920-7457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARYN SHERFIELD
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 877-667-7669