Healthcare Provider Details

I. General information

NPI: 1326167354
Provider Name (Legal Business Name): JARED M BROWN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11748 S 3600 W
SOUTH JORDAN UT
84095-5922
US

IV. Provider business mailing address

11748 S 3600 W
SOUTH JORDAN UT
84095-5922
US

V. Phone/Fax

Practice location:
  • Phone: 801-938-3412
  • Fax:
Mailing address:
  • Phone: 801-938-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6653
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: