Healthcare Provider Details

I. General information

NPI: 1124020920
Provider Name (Legal Business Name): JARED R. ANDERSON DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 SW RIMROCK DR
REDMOND OR
97756-1941
US

IV. Provider business mailing address

774 SW RIMROCK DR
REDMOND OR
97756-1941
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-7633
  • Fax: 541-923-8733
Mailing address:
  • Phone: 541-923-7633
  • Fax: 541-923-8733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6510C
License Number StateOR

VIII. Authorized Official

Name: DR. JARED R. ANDERSON
Title or Position: OWNER/OPERATOR
Credential: DDS
Phone: 541-923-7633