Healthcare Provider Details

I. General information

NPI: 1639003072
Provider Name (Legal Business Name): JARED MICHAEL FORD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 E SKYLINE DR STE 400
SOUTH OGDEN UT
84405-4856
US

IV. Provider business mailing address

1508 E SKYLINE DR STE 400
SOUTH OGDEN UT
84405-4856
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-6500
  • Fax: 801-479-5904
Mailing address:
  • Phone: 801-475-6500
  • Fax: 801-479-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11051522-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: