Healthcare Provider Details

I. General information

NPI: 1578903670
Provider Name (Legal Business Name): JARON TRAVELLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 S CREEK RD SUITE 101
SANDY UT
84093-6158
US

IV. Provider business mailing address

1913 W 500 S
CEDAR CITY UT
84720-2894
US

V. Phone/Fax

Practice location:
  • Phone: 801-561-8131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6134075-9922
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: